Although largely funded by the Australian Government, the NSP is administered by the State and Territory Governments. Both government and community-based agencies – including in some cases drug user support and advocacy groups – are involved in delivering NSP services in various locations. There are some differences from one part of Australia to another in the ways in which NSP services are managed and delivered, and in the ways that issues relating to Indigenous access have been approached. Appendix B to this report provides some background information on services, issues and strategies in various jurisdictions.
The broad pattern is that in each State or Territory there are some primary NSP services, which have been established specifically to provide harm reduction services to IDUs and are staffed by specialist workers. Apart from making available clean injecting equipment, primary NSP outlets are designed to provide information and education, client advice and support and appropriate referrals. They also represent an important ongoing source of information on patterns of drug injecting behaviour, and may play a significant role in developing partnerships with and offering information and workforce training for other services. In most cases primary outlets provide clean needles and syringes to clients free of charge, though there may be a charge for other injecting items such as sterile water, filters, nonstandard barrels and the like.
The range of equipment provided at NSP outlets ... varies across and within jurisdictions, partly in response to the types of drug being injected. As a minimum, NSP services provide needles and syringes, alcohol swabs and sharps containers for the safe disposal of used needles and syringes. NSP outlets may also provide condoms and lubricant and further injecting equipment, including sterile water, spoons, filters, winged infusion sets and tourniquets, sometimes on a cost-recovery basis.
Typically, NSP outlets also accept and provide for appropriate disposal of used injecting equipment13.
Primary NSP services are limited in number, and are complemented by secondary services that operate in a variety of settings – in particular, hospitals and community health centres. These are outlets where NSP activity is incidental to the service provider's other responsibilities; the staff involved in distributing injecting equipment (usually at no charge) will generally have received some degree of information or training relating to this role. At community health centres, sexual health services and the like, the staffmember responsible is often the receptionist. Hospitals generally provide their NSP service through their Accident/Emergency departments, and play an important role in distribution because they are open at all hours (in many cases hospital-based NSP service are available only after hours).
Primary NSP outlets mostly operate at a fixed site, but some offer (in addition or instead) a mobile service by vehicle or occasionally by foot, which follows an established route and timetable to provide greater geographical coverage and to reach people who may be unable or unwilling to access a fixed site. Outreach services also involve distribution beyond the confines of a fixed site; these may involve workers travelling to various locations where they can expect to find groups of IDUs, and/or delivering equipment to particular groups of people or particular locations – possibly including some people's homes14.
Many NSP outlets provide a return/disposal facility, without necessarily requiring that there be an exchange of equipment. Some set limits on the distribution of new equipment if used fits are not returned. In some cases clients of secondary NSP outlets can collect pre-packaged equipment from a cupboard or shelf without needing to have any contact with staff.
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In some jurisdictions there are small numbers of Aboriginal health services or other Indigenous-specific agencies which act as secondary NSP services; historically there have been more of these in New South Wales than elsewhere. In general, as later sections of this report emphasise, Aboriginal medical services have not to date been particularly keen to take on this role, and in any event Indigenous IDUs have not necessarily been enthusiastic about using Indigenous-specific services.
In all jurisdictions community pharmacies play a significant role in the distribution of sterile injecting equipment – though that role is generally less central than it was in past years when primary and secondary services were less developed. Participating pharmacies are authorised to sell clean injecting equipment – which typically comes pre-packaged as a set of three or five needles and syringes, possibly with other equipment such as swabs, brief printed information on safe injecting and possibly a container for safe disposal (Fitpacksa are designed in such a way that the plastic container holding the needles and syringes also provides a built-in disposal facility). The current charge for five needles is typically around $6 or $7. In New South Wales pharmacies a client can obtain a replacement Fitpack free on return of a used pack.
Vending or dispensing machines are available in several jurisdictions – but only in any significant numbers in New South Wales. From the consumer's perspective these machines offer the advantage of anonymity and unlimited hours of availability, although a small cost is usually involved. From a service provider's perspective, maintaining the machines and keeping them stocked can be something of a challenge, and there are also some complexities in determining what sorts of sites (eg in terms of visibility to passers by, ensuring safety for users and the like) are most suitable for this purpose.
In general the availability of NSP services is not widely advertised, with the result that word-of-mouth information is particularly important. Typical means of informing people about NSPs include brochures that may be displayed at health centres or other community services. Websites are used in some cases. In Mildura the study team heard that these sorts of methods are supplemented by community service announcements or late night television.
There are hepatitis C policies relating to Indigenous Australians at Commonwealth and at State level. Access to NSPs is identified as a strategic priority in the National Aboriginal and Torres Strait Islander Sexual Health and Blood-borne Virus Strategy. Several of the States and Territories have from time to time undertaken specific projects or initiatives with the aim of more effectively reaching and providing services for Indigenous IDUs. However, the point was made by stakeholders consulted during the present study that the funding for such initiatives has typically been short-term, and that realistic timeframes and ongoing funding are required if these issues are to be tackled more systematically
At national level, Hepatitis Australia in 2006-07 conducted a project designed to map and scope hepatitis C education and prevention activities targeting Indigenous communities, and to identify priorities for future action. Among other things that work involved surveys of Aboriginal Community Controlled Health Services (ACCHSs) and of other relevant mainstream and community organisations. It identified a need for parallel streams of activity within the Indigenous health sector and in mainstream health, including expanded hepatitis C training for those working in community controlled health services and relevant cultural awareness training in the mainstream. It recommended collaboration on production of a 'culturally appropriate consumer information resource targeting Aboriginal and Torres Strait Islander people', collaboration in establishing hepatitis C workshops for the Indigenous health workforce, promotion of the benefits of NSPs 'in all hepatitis C and BBV education programs for ATSI community health workers, clinical staff and community leaders', and workshops to facilitate 'the sharing of information and experiences of successful NSP provision by ACCHOs'15.
13 Department of Human Services, Victoria, Victorian NSP Status Report, May 2007.
14 The terms 'mobile' and 'outreach' are used in slightly different ways in different locations. For SAVIVE in Adelaide, for example, a mobile service involves responding to phone calls requesting equipment, while an outreach service is proactive, 'going out to where people are'. In this report a 'mobile' service is generally one which follows a consistent path and timetable.
15 Troy Combo, 'Mapping and scoping of hepatitis C education and prevention activities targeting Aboriginal and Torres Strait Islander Communities' - presentation at the Melbourne workshop on hepatitis C, June 2007.
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