Those consulted during this study often observed that for any drug injector there may well be an initial barrier of fear or uncertainty to overcome before accessing an NSP service, and therefore that new/young/experimental IDUs tend to avoid using such services. This research suggests that for an Indigenous IDU approaching a mainstream service such hesitation and concerns are generally likely to be all the greater.
Accordingly it has sometimes been suggested that services for Indigenous IDUs need to be 'culturally appropriate'. A stakeholder interviewed in Alice Springs argued, however, that this makes little sense, because drug injecting effectively involves an abandonment of Indigenous cultural tradition. ('You take on another persona'; 'Culture goes out the window'.) Much the same view was put in Cairns ('the drug scene carries its own culture') and in Perth ('the drugs overtake' racial traditions or divisions)35. Further, as noted in section 3.2.1, the importance of keeping one's drug use private from relatives or other community members can militate against using an Indigenous-specific agency that offers NSP services. Nevertheless it was clear that mainstream services could be intimidating or off-putting for some Indigenous IDUs, and IDUs who were interviewed by the study team tended to say that they would value at least having some access to Indigenous NSP workers. 'We can talk freely' to other Aboriginal people – especially people who have personal experience of drug injecting; with an Aboriginal peer it is 'easier to talk openly' (Alice Springs). Aboriginal IDUs interviewed in Western Sydney similarly said that they would like to have an Aboriginal worker at the NSP ('We'd open up just that bit more'). However, the present, non-Aboriginal workers were well regarded ('They're pretty cool'), and these clients felt welcome and well cared for.
The researchers encountered some NSP outlets (eg REPIDU in Sydney and WAAC in Perth) which employed, or had at some time employed, Indigenous workers36 but this did not seem common. In some cases (for example at the outlets operated in Darwin and in Alice Springs by the NT AIDS and Hepatitis Council) there were Indigenous staff-members who were employed in other roles in the organisation but who performed NSP duties as required. The NTAHC primary NSP in Darwin reports having had Aboriginal volunteer workers from time to time, and there is currently an Aboriginal staff member who works part-time in the NSP. Carnarvon has in the past has an Indigenous NSP Coordinator – from outside the town – who reported useful progress in networking with Indigenous IDUs.
Some non-Indigenous staff-members at NSPs indicated that they themselves felt very comfortable working with Indigenous clients, and believed the clients were likewise comfortable with them. However, especially in secondary outlets such as community health centres, where NSP services are often provided 'over-the-counter' by a receptionist, this may not always be the case.
While having Indigenous staff-members could be a positive for some clients, others – particularly in regional or rural areas, whose population numbers are smaller – may see it as a threat to privacy. For instance 'one young bloke' was described as having been very nervous when he encountered an Aboriginal worker at the NTAHC NSP outlet in Alice Springs. Thus it was sometimes said that it was generally more straightforward to employ Indigenous workers in city services, or that it was desirable to find a worker who came 'from somewhere else'. NSP staff consulted in western Sydney suggested that Indigenous outreach workers could certainly play a valuable role in extending the reach of services.
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In Alice Springs, Clinic 34 was said to have a good general reputation among local Aboriginal people, which meant that in terms of Indigenous IDU access it provided an appropriate secondary site. Similarly, the Youthlink service in Cairns was thought likely to be seen as an Indigenous-friendly NSP outlet, since most of the clients of the youth service itself are Indigenous. In Cairns the local QuIHN office was described as offering a friendly and supportive atmosphere that helped to attract Indigenous IDUs. Indigenous clients tend to like a service that has an 'easy-going' style, it was said.
Port Augusta provided an example of a service that was reported to work well for Indigenous IDUs. The local NSP is located at the Sobering Up Unit, which is generally regarded as an Aboriginal service and is largely staffed by Aboriginal workers. Given the nature of their usual role in working with intoxicated people, however, these workers could be seen as experienced and realistic in relation to drug issues, and less likely to be shocked or judgemental than, say, some health workers at an Aboriginal medical service might be. Other advantages of this particular service were that it is discreetly located (in a quiet street near the hospital, on the outskirts of town), and that it is open 24 hours a day, six days a week – with injecting equipment always available from the nearby hospital Emergency Department as a back-up. (On the other side of the ledger, the Sobering Up service may perhaps be perceived as a largely male service, and some 75% of client contacts were said to be with males.)
In several locations it was noted that NSP staff had received no cultural awareness training to assist them in working with Indigenous clients. In Melbourne, however, the drug and alcohol agency Turning Point (which offers an NSP service among other things) was in mid-2007 undertaking an Indigenous cultural awareness training program for its staff; the Victorian NACCHO affiliate, VACCHO, was working with them on this. At Taree an Aboriginal Liaison Officer has been appointed to the Community Health Centre, and this was seen as a positive step in promoting Aboriginal access to NSP services available there.
Other simple actions taken by some outlets to project an Indigenous-friendly message include display of appropriate posters, pamphlets and the like. (It appears that overall there is not a great deal of Indigenous-specific material readily available on issues such as safe injecting. However, such material has certainly been developed and produced in the past. Relevant initiatives have included OATSIH funding to AIVL to design and produce a number of Indigenous-specific brochures – see also section 3.2.7 In Sydney a mainstream western suburbs NSP reported flying the Aboriginal flag, which had become 'a bit of a landmark'.
There were some mixed views expressed in Darwin and Alice Springs on the appropriateness and accessibility of the NTAHC primary outlets for Indigenous IDUs. One observer, for example, was of the view that NTAHC tended to be perceived in the Aboriginal community as a white people's place, a gay men's place and an HIV place – none of which was especially likely to encourage usage by Aboriginal IDUs, or by women in particular. On the other hand an NTAHC representative in Alice Springs stated that 'We have very good relationships with our Indigenous clients', and it was apparent that some Aboriginal IDUs in Alice Springs, both male and female, regarded the NTAHC outlet as their preferred service; its advantages were described by one client as including knowledgeable staff, 'someone to talk to', good availability of equipment (including, for example, filters), and the availability of relevant information, magazines and the like. An NTAHC client in Alice Springs commented that there were certainly initial barriers of fear and uncertainty for people to overcome, but that 'once they get there they think it's good'. In Carnarvon it was reported that the NSP outlet operated by Population Health at its Communicable Disease Centre was commonly referred to as 'the AIDS House', and that this was not helpful in promoting its use by a full cross-section of IDUs.
In Darwin it was suggested that 'urban' Aboriginal IDUs would far more readily access a mainstream NSP than would people from more isolated or traditional backgrounds. Workers at one NSP made the point that language could be a barrier or an embarrassment for some potential clients, and that people who were not fluent in English were not generally likely to approach a mainstream NSP outlet.
It was notable that some NSP services, while having Indigenous clients, seemed not to have given any particular consideration to their needs or characteristics. 'I didn't think much about Indigenous till you rang', said one service manager to a member of the study team. The point was also made that it could be very difficult for a mainstream service to know how well it was doing in terms of Indigenous access. As noted elsewhere, in the past NSP services have tended not to get much input or feedback from, say, the Indigenous health sector. The situation is improving in this regard, however, with bodies such as VACCHO and the AH&MRC in New South Wales taking a more active role issues relating to hepatitis C.
A number of the issues considered in this subsection and in section 3.2.1 are reflected in a checklist for the location and presentation of sexual health and related services that comes from the 2004 AH&MRC/Mandala Consulting report on Increasing Access to Services in NSW for Aboriginal People at Risk of Contracting or who Have Blood Borne Infections. That report suggests that relevant services should:
- be close to reliable and regular public transport
- be in a discreet location, away from high traffic/visibility gathering points or services
- not be in obvious proximity to security or law enforcement services
- have minimal reception barriers to be crossed
- be signposted in an appropriate way that de-stigmatises the main role of the service
- offer multiple access points (eg shopfront, vehicle, foot)
- display visible indications that the service is Koori-friendly – eg naming, posters, use of colours and symbols37.
35 The 2004 ACT report 'I want to be heard' refers (p 30) to Aboriginal community concern at drug injectors being 'immersed ... in a totally alien way of life'.
36 The clearest example of Indigenous staffing was provided by the outreach service based at Nunkuwarrin Yunti in Adelaide, which involves a small team of Aboriginal workers and targets homeless Aboriginal drug users.
37 Quoted in Implementation Plan for Aboriginal People (NSW HIV/AIDS, STIs and Hepatitis C Strategies), p16.