Hepatitis C (HCV) is very prevalent among injecting drug users (IDU). Control of this infection poses a major challenge to harm reduction services. Education of all IDU regarding HCV constitutes part of the harm reduction programme.

The authors sought to assess understanding of HCV among IDU attending an addiction treatment clinic and to identify whether or not those with increased contact with health professionals demonstrated better understanding. A total of 105 IDU were interviewed to assess their knowledge regarding modes of transmission and chronicity of HCV infection. They had first injected an average of 10.0 years previously. Interviewees were more successful at identifying activities which carried a risk of HCV transmission than they were at identifying activities which posed no risk of infection. Over one-third falsely believed that one could contract HCV infection even when injecting `safely'. Understanding of the long-term nature of HCV infection was also impaired. A group on methadone maintenance for a median period of 1.4 years failed to demonstrate significantly better knowledge than those attending for a 21-day detoxification. Those in frequent contact with a GP performed less well than those without such contact. Understanding of HCV among IDU is inadequate and must improve if primary prevention efforts are to succeed.

The authors question the value of didactic approaches to educating IDU and call for a more experiential teaching style which may be more successful at countering prevalent misconceptions.