BACKGROUND AND AIMS:Of the 259,000 Australians estimated to have a hepatitis C virus infection, very few have received antiviral therapy. This study identifies personal, psychological and structural barriers associated with decisions to begin treatment and the challenges associated with adhering to a demanding treatment regimen. METHODS:Between August 2003 and May 2004, 224 people living in Victoria who were hepatitis C antibody positive completed a 78-item survey instrument. Participants were recruited from a variety of settings and included those who were on treatment for hepatitis C (n=45); previously on treatment (n=65); and people who had never experienced treatment (n=114). RESULTS:The average age of the participants was 43 years. Men (n=29) were more likely than women (n=15) to be receiving treatment. Participants diagnosed in the past five years (31%) were more likely to be receiving treatment compared with those diagnosed more than five years ago (14%). Participants rated the effectiveness of treatment as the most important factor in influencing their decision to begin treatment. Side effects were rated the biggest challenge to adhering to treatment and were also rated as the most important consideration for those who decided against treatment. CONCLUSIONS:This study has shown many decisions and challenges affect the uptake of, and adherence to, hepatitis C treatment. Dissemination and promotion of information about increased effectiveness of new treatments will greatly influence decisions to begin treatment. Careful management and minimisation of side effects are also essential to improve uptake and increase adherence to hepatitis C treatment.