This research confirms the lack of reliable data both on the extent of drug injecting among Indigenous Australians, and on Indigenous IDUs' use of NSP services. Client contact data collected through NSP services, for example, are of limited value in this context because of variability in information recorded on Aboriginality. While some NSP services report keeping records on Indigenous status, many do not. In South Australia, for example, only services which are specifically funded to address the needs of Indigenous IDUs are required to collect information on the Indigenous status of NSP contacts. Where information on Indigenous status is recorded by NSPs, it is evidently common for workers not to ask clients whether or not they are Indigenous, but rather to record their own impression on this (as is often the case for age, also). Information on numbers or proportions of Indigenous client contacts at NSPs is therefore uneven and in part a matter of guesswork19. It is also important to note that since NSP data normally refer to client contacts rather than numbers of individual clients; there is no reliable way of relating these data to numbers of IDUs or frequency of injecting.
The annual Australian NSP Survey is not designed to provide an accurate estimate of the proportion of NSP clients who are Indigenous (nor, of course, to estimate numbers of Indigenous IDUs overall). Nevertheless it is of interest that around 10% of the NSP clients who participated in annual surveys between 2003 and 2007 were Indigenous20. Appendix G sets out Indigenous population percentages for each state and Territory (based on the 2006 Census), together with the corresponding percentages of respondents to the 2007 NSP Survey who were Indigenous. Everywhere except in the ACT, Indigenous representation in the survey was higher than Indigenous representation in the total population, and in the ACT (where the NSP sample is small) this was true in the previous year's survey. It is not completely clear what conclusions can be drawn from these figures, but we can reasonably say that:
- they are consistent with the proposition that the incidence of injecting drug use is relatively high in the Indigenous population; and
- they show that Indigenous IDUs' current use of the NSP is far from negligible overall.
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At most of the locations visited by the study team, people whom they consulted believed that there were significant levels of local Indigenous drug injecting. Some IDUs interviewed in Western Sydney, for example, described Indigenous drug injecting as quite common: 'Everybody knows someone who's involved'. In some locations the view was that there were certainly Indigenous IDUs, although it was difficult to say with any confidence what the numbers might be. Several of those who were interviewed in Alice Springs, however, believed that there was at present relatively little drug injecting among Aboriginal people in Central Australia; Indigenous hepatitis C rates in Central Australia – for example as recorded through prison screening – were described by one professional as 'incredibly low'. 'All the hepatitis C patients' at Alice Springs Hospital, it was said, were non-Indigenous. In Mt Isa the general opinion among those consulted was that there was little Indigenous drug injecting in that area21.
Stakeholders consulted in several locations described injecting use among Indigenous Australians as having increased over recent years. In Port Augusta, for example, a number of those consulted believed that there had been more injecting by Aboriginal people over the past year or so; possibly this reflected the fact that there was more money in the town as a result of nearby mining activity, attracting increased supplies of drugs and increased drug injecting generally. An IDU interviewed in Alice Springs similarly believed (perhaps contrary to the view reported above) that injecting had become more common among Indigenous people in that area in recent years – 'getting pretty bad, eh'. WASUA staff consulted in Perth believed that where there had once been only a 'small hard core' of Indigenous IDUs, drug injecting has become considerably more common22. 'More traditional' Aboriginal people, said an IDU in Cairns, are often reluctant to use a needle; in this population there were consequently 'more sniffers'. In her view, however, injecting (and unsafe injecting) was increasing.
A number of stakeholders indicated that they would like to see national discussion and agreement on whether and how Aboriginal or Torres Strait Islander identity should be recorded by NSPs – even if only on a sample basis. They made the point that funding is needed to support the gathering of more reliable data on such matters as the level and patterns of Indigenous drug injecting, and risk behaviour among Indigenous young people.
Although there was general acknowledgement of the existence of drug injecting among Indigenous Australians, it was frequently observed that alcohol, tobacco, marijuana, and in some locations petrol sniffing, continue to represent the most common drug issues within Indigenous communities. Port Augusta, for example, was described by one worker as 'pretty much an alcohol and cannabis town'; nevertheless, as noted above, injecting drug use was thought to be increasing there – possibly influenced by the money generated by mining operations in the region.
19 Workers at numbers of NSPs referred to the importance of not 'hassling' clients with too many questions. AN IDU in Cairns commented favourably on the speed and simplicity of using a particular NSP outlet – 'You're straight in and out'.
20 Australian NSP Survey; National Data Report 2003-2007, National Centre in HIV Epidemiology and Clinical research, p9.
21 'Everyone's related to bloody everyone' in the long-established Aboriginal community in Mt Isa, so that it is 'pretty hard to keep anything secret'. One Mt Isa worker said that the Aboriginal IDUs whom she did see tended to be from out of town, newcomers. They were generally occasional rather than dependent drug users, she believed.
22 An information sheet on the NSP in Western Australia, issued in May 2007 by the Communicable Disease Control Directorate of the WA Health Department, states that 'Nationally, it had been noted that there is an increase in injecting drug use in Indigenous youth ...."