The researchers heard frequently that many people within Indigenous communities have some difficulty with the harm reduction approach embodied in Needle and Syringe Programs; this point has been frequently made in earlier research (see Appendix C). It was reported that, for various reasons, abstention philosophies tend to be particularly strong across Indigenous organisations and communities, and that the notion of offering an NSP service thus tends to be controversial38. Indigenous community embrace of an abstinence approach was attributed to a number of different factors, including a continuing legacy of Christian mission influence and the fact that alcohol has had such disastrous impacts in many Indigenous communities.
A Western Australian stakeholder described ACCHS commitment to an abstinence philosophy and resistance to NSP services as 'fairly pervasive'. The Drug and Alcohol Service of South Australia (DASSA) has had relatively little success with a program, pursued over the past four years, aiming to increase the number of organisations in the community – particularly Aboriginal medical services – willing to act as NSP outlets. Staff interviewed at one ACCHS thought that their patients and the local community would be responsive to harm reduction messages and approaches, but that the Board would find provision of an NSP service hard to accept.
Across the country, the number of community controlled health services which participate in a Needle and Syringe Program is relatively small. In Victoria, for example, it was reported that only three of the State's 26 Aboriginal medical services offer any NSP service; the position was similar in Western Australia and South Australia. In NSW the number of ACCHSs involved in providing NSP services has gone up and down over time, but the numbers are currently small.
Apart from possible adherence (by elders, Board members, staff) to an abstinence approach to drug and alcohol issues, reservations about NSP services as such are compounded by 'the crowded Indigenous health agenda'. That is, those working in Indigenous health face such a range of serious and widespread health problems that it is not surprising if an issue like hepatitis C prevention comes a long way down the priority list. Other reasons cited as underlying AMS/ACCHS reluctance to provide NSP services included the following:
- lack of funding for such organisations to offer NSP services
- lack of relevant training among staff members
- limited access to drug and alcohol staff or expertise in general
- difficulties in incorporating services for IDUs into what are seen as core health service responsibilities – including, for example, ensuring a positive environment for families or 'mums and bubs'
- belief that IDUs can be a challenging and time-consuming client group
- concerns about negative impacts on reputation if the wider community came to associate Indigenous health services with drug injecting issues
- concerns in particular about negative impacts on relationships with neighbouring households or services in particular
- concern about possible legal implications – for example of making injecting equipment available to minors or to people for whom this might involve a breach of bail or parole conditions.
Given concerns within some Indigenous communities about NSPs being seen as 'encouraging our people to use drugs', it is clearly important to focus on effective ways of building community awareness and understanding of the value, for the whole community, of a harm reduction approach. People consulted by the study team suggested that this requires a holistic approach that places NSPs clearly in a broader health context. While Indigenous community members might be reluctant to engage in discussion of health issues among drug injectors, they were thought much more likely to respond to messages about 'preventable chronic disease'. Possibly community acceptance of NSP services may more readily be forthcoming for services which clearly do more than simply issue clean equipment – for example, 'enhanced' services such as are referred to in section 3.1.5.
38 Strong adherence to an abstinence philosophy is also reported among Indigenous communities in Canada – see eg Dell C and Lyons T, Harm Reduction policies and programs for persons of Aboriginal descent, Canadian Centre on Substance Abuse, June 2007.
In the present study it was reported that conflict between abstinence and harm reduction principles was an issue that regularly arose within the national training program for Indigenous drug and alcohol workers. For some Aboriginal workers engaged in harm reduction activities, it was said, the first task is to 'convince yourself' of the appropriateness of this approach. An Aboriginal NSP worker in a country town commented that he found it quite difficult when he had to give out injecting equipment to young people whom he knew.
39 As previously indicated, there were several instances where ACCHS personnel gave the study team what turned out to be inaccurate information about needle and syringe availability, or simply did not appear to know much about the services available.