The everyday violence of hepatitis C among young women who inject drugs in San Francisco

A theoretical understanding of the gendered contours of structural, everyday, and symbolic violence suggests that young addicted women are particularly vulnerable to the infectious diseases caused by injection drug use-especially hepatitis C. Participant observation among heroin and speed injectors in San Francisco's Haight Ashbury neighborhood reveals that extreme levels of violence against women are normalized in the common sense of street-based youth drug culture. Physical, sexual, and emotional violence, as well as the pragmatics of income generation, including drug and resource sharing in the moral economy of street addicts, oblige most young homeless women to enter into relationships with older men. These relationships are usually abusive and economically parasitical to the women. Sexual objectification and a patriarchal romantic discourse of love and moral worth lead to the misrecognition of gender-power inequities by both the men and women who are embroiled in them, as well as by many of the public services and research projects designed to help or control substance abusers. Despite deep epistemological, theoretical, and logistical gulfs between quantitative and qualitative methods, applied public health research and the interventions they inform can benefit from the insights provided by a theoretical and cross-methodological focus on how social power contexts shape the spread of infectious disease and promote disproportional levels of social suffering in vulnerable populations.