People consulted by the study team often made the point that young people injecting drugs were particularly vulnerable to associated health risks, as a result of possibly limited knowledge and relative inexperience coupled with fear or uncertainty about approaching services. A worker in Cairns, for example, suggested that it possibly took a typical IDU a year or two to 'start to interface' with an NSP – ample time to suffer the consequences of not using clean equipment. According to NSP staff consulted in western Sydney, after two years of injecting around 50% of IDUs have become infected with hepatitis C; it was suggested that this situation was likely to be exacerbated among young Indigenous IDUs by additional cultural barriers to accessing mainstream services. 'Eighty per cent of the young injectors we see turn out to have hep C', said an Indigenous youth worker in Canberra. 'By the time they get here', said a Melbourne NSP worker, 'a lot already have hep C' – and 'bad habits'. Since there is such a large Indigenous youth population and since people tend to pick up hepatitis C very early in their using life, said a Carnarvon worker, reaching young people is crucial; a Perth stakeholder used virtually the same words.

Various aspects of the 'image' of NSPs were mentioned by some observers in this context – for example a perception that NSP clients tended to be older, more established drug injectors. One reason why some younger IDUs might be reluctant to use NSP outlets, therefore, was a wish to avoid being identified with 'those old junkies'.

Accordingly many of those consulted were concerned to find ways of reaching Indigenous young people with relevant information and support. Numbers of stakeholders, for example, referred to a the lack of education on such issues at high school, and believed that appropriate education at junior secondary school level was likely to be the most effective way of doing this – though others argued that getting such an approach accepted in schools was likely to be a slow and difficult task40. Another suggested option was to ensure that a wide range of youth workers and organisations have the necessary skills and resources to make young people – and Indigenous youth in particular – aware of key issues around injecting drug use, including the need to protect themselves against blood-borne infection if they should become involved. Publications in the style of Streetwize comics were seen by a number of stakeholders as valuable in this context.

A current NSW Health strategy document dealing with sexually transmitted infections and blood borne viruses notes the young age profile of the Aboriginal population and suggests that 'key settings for reaching young Aboriginal people at greatest risk' include:

(s)ettings which are primarily populated by young people, including places where young people 'hang out' or other settings such as Juvenile Justice Centres, school homework centres, youth centres, and other settings where activities such as sex work (including 'sex for favours') may take place ....41


40 The importance of including safe injecting information in school drug education programs was identified in numbers of the centres visited, including Adelaide, Sydney and Cairns.
41 NSW Health, Implementation Plan for Aboriginal People (NSW HIV/AIDS, Sexually Transmissible Infections and Hepatitis C Strategies), p 25.