• There were many similarities in the issues raised by those consulted over the course of the study, whether they lived in metropolitan areas or in large or small towns. However there are of course some obvious differences in the situations which people face in city and country locations.

  • Given that relatively more Indigenous than non-Indigenous Australians live outside the major cities, adequacy of NSP coverage and service quality in regional and rural areas represents one important element in providing appropriate access for Indigenous IDUs. Barriers to access, however, are in general most obvious in country areas, where there are likely to be relatively few options available and where small population numbers make privacy both particularly important, and quite problematic. We have noted the comment of one observer in Alice Springs, for example, to the effect that confidential access is very difficult to achieve in a town of that kind. In smaller centres the most likely source of clean injecting equipment - apart from friends - is either the Hospital Emergency Department or the community pharmacy, so that quality of access very much depends on how effectively these perform and on their reputation among clients and potential clients. In this context appropriately trained staff who treat clients well, and who understand the importance of privacy and discretion, are probably the most effective enabler.

  • Access to NSP services is generally even more limited in rural or remote areas than in country towns. In Cairns it was reported that although hospitals in Cape York communities such as Lockhart River do offer clean injecting equipment, local Indigenous clients are unlikely to be comfortable using these, generally preferring to rely on obtaining equipment when they - or others - visit Cairns. The evidence of this study was that primary outlets in places such as Cairns, Alice Springs and Darwin are generally well aware of the needs of clients who come into town only at limited intervals, and who may be taking responsibility for distributing equipment to others at home.

  • Indigenous IDUs living in the cities are in general likely to have more options available to them, and to find it easier to avoid NSP outlets in places where they may be known or recognised. However, clients in metropolitan areas may choose to travel some distance in order to ensure greater privacy, and accessibility of services by public transport was therefore identified as an important issue.

  • Both in the city and in country locations, vending machines were seen as having the potential to significantly improve access, with the chief benefits being anonymity and unrestricted hours of availability. Not having coins, or the correct coins, was a possible barrier to vending machine access: there were some suggestions for introducing tokens of some kind or possibly a 'swipe card'.

  • Another practical issue raised by those consulted was that the availability of drugs can vary significantly between country and city areas. By and large, heroin was more difficult to obtain - and more costly - outside the large cities, so that amphetamines and other options such as morphine were more typical of injecting in regional and rural areas. Further, given the cost and the unreliability of drug supply in more distant or isolated areas, injecting was likely to be sporadic or opportunistic rather than regular. A number of stakeholders suggested that this was likely to increase the chances of unsafe behaviour.