B3.1 NSP ServicesBoth government and non-government agencies provide NSP services in Western Australia. The program is co-ordinated and managed by the Sexual Health and Blood-borne Virus Program (SHBBVP) of the Communicable Disease Control Directorate, Department of Health. In 2006, 4.2 million needles and syringes were distributed in WA.
The WA Poisons Amendment Act (1994) allows approved organisations to provide sterile injecting equipment to people who inject drugs. WA has three main types of service: needle and syringe exchange programs (NSEP); NSPs based within health services (eg hospitals, community health centres); and pharmacy-based services. Regional coordinator positions are located in the Great Southern, Kimberley, Southwest, Midwest and Wheatbelt regions; these positions are supported by COAG funding to offer increased education, counselling and referral through community based organisations and support diversification of existing needle and syringe programs.
Primary outletsCurrently around 50% of WA's needle and syringe distribution is provided through NSEPs which are operated by non-government organisations, funded through the SHBBVP. In Perth the WA Substance Users' Association (WASUA) has a fixed primary outlet, while the WA AIDS Council (WAAC) provides a fixed outlet as well as a mobile service. WASUA also operates a mobile service in the south-west of the State.
Both WASUA and WAAC supply clean needles and syringes at no cost to the client, conditional on the return of used items, ie exchange; if no exchange takes place a cost recovery price is charged. WAAC reports that swabs are provided free, and sterile water at cost price. A range of other items of injecting equipment is available for purchase from both WASUA and WAAC. WAAC's exchange policy was described as 'strict, but with some flexibility' in appropriate circumstances; staff aimed to work within 'clear boundaries' which are said to be generally respected by clients. It was reported that Indigenous clients, in particular, tend to ask for only small numbers of fits, suggesting to NSP workers that they cannot afford to inject frequently/consistently3. Although legislation relating to possession of used equipment remains 'on the books' in Western Australia, the Police policy was said to be not to interfere with people carrying equipment for return to an NSEP.
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In Perth WASUA operates a fixed primary outlet in the inner city, backed up by some outreach work; its operation in the south-western region of the State is a mobile service4. These are peer-based services. The fixed outlet in the city operates six days a week (to 8pm on Thursday and Friday). It also offers free BBV and STI testing, with pre and post test counselling, and free hepatitis A and B vaccinations (these BBV/STI services are supported by DoHA Hepatitis C Education and Prevention funding). It also offers information and supported referral to alcohol and drug treatment, housing, social and legal services; support and advocacy for people on pharmacotherapy programs; and peer support, information, referral and advocacy for people with hepatitis C or at risk of infection. Outreach work in the Perth metropolitan area focuses on providing equipment to people likely to have difficulty accessing a fixed outlet (eg those with a physical disability), or on reaching locations where there are known to be high concentrations of users. This outreach service averages some 15-30 client contacts a week – far fewer than the fixed outlet (which had around 5,000 client contacts in a recent 6-month period). About 5% of client contacts overall are recorded as Indigenous.
WAAC provides both a mobile service and a fixed outlet in Perth. Staffing of the mobile service currently includes two Aboriginal workers; it visits ten sites across metropolitan Perth each week (Monday to Saturday), spending at least two hours at each site in the afternoon or early evening. Operations at each site need to be approved by the local Council, and the locations are publicised through use of flyers and the like. The program is partly financed through COAG funds, which have enabled expansion to several outer suburban sites.
WASUA and WAAC coordinate their buying of supplies from wholesalers.
Secondary outletsNSPs based in government health services distribute free sterile equipment in the form of Fitsticksa (five sterile NS with approved disposal device packaged in a plastic bag), which are provided at no cost to the service by the SHBBVP.
Under an Operational Directive issued by the Director General of the Department of Health, all regional and rural hospitals in Western Australia that provide emergency after-hours services are required to provide after-hours access to needles and syringes (free of charge) for people who inject drugs. Some hospital Emergency Departments offer a 24-hour service. NSP services are also available from some community health centres, population health clinics and the like.
PharmaciesPharmacy based services operate on a commercial basis through the sale of Fitpacka and Sterafita . It was reported that the majority of community pharmacies in Western Australia sell needles and syringes. To do so, pharmacies require an approval from WA Health, but the Pharmaceutical Council has obtained a 'blanket' approval for pharmacies to sell a small number of standard products such as packs of 3 or 5 needles and syringes. Some pharmacies also sell 'singles', but require an individual approval to do so.
Community pharmacies are currently responsible for about one-third of the distribution of needles and syringes across the State (until about 2000, before the establishment of new primary outlets, pharmacies distributed about two-thirds of the total). In many WA towns the pharmacy remains the only source of clean needles.
The Hepatitis C Council has offered some training for pharmacists and pharmacy assistants, and has also trained undergraduate pharmacy students. Some pharmacies may also provide their own in-store training. There was reference in WA to some pharmacies deterring potential customers by charging unusually high prices.
Vending machinesAs of late 2007 Western Australia's only vending machine was located in the grounds of Kalgoorlie Hospital. A number of additional vending machines were about to be introduced in other regional locations.
Aboriginal Medical ServicesIn Western Australia only three Aboriginal Medical Services (two of them community controlled) currently offer an NSP service.
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B3.2 Serving Indigenous clientsThe WA Action Plans for hepatitis C and for HIV both identify Aboriginal people as priority target groups.
Aboriginal BBV prevention scoping projectIn 2007-08 the Practice Development Branch of the Drug and Alcohol Office undertook a scoping project to determine how workers and organisations in Western Australia could be better supported through workforce development to provide blood borne virus harm reduction services (in particular, needle and syringe programs) to Aboriginal IDUs. The decision to conduct this study came after the SHBBVP had experienced little success in earlier efforts to engage with a number of Aboriginal Medical Services. Workers and organisations consulted included the following: Aboriginal Community Controlled Health Organisations, Aboriginal Health Workers, the Aboriginal Alcohol and other Drug sector, the mainstream AOD sector, BBV and NSP sectors. The project focussed on two non-metropolitan locations.
The objectives were to:
- identify barriers and enablers to ACCHOs providing NSP and other harm reduction services for Aboriginal people who inject drugs
- identify barriers and enablers in other sectors for providing blood borne virus harm reduction services for Aboriginal people who inject drugs
- make recommendations as to strategies to address barriers and capitalise on enablers
- inform the development of a sustainable model for providing targeted best practice training to support ACCHOs to implement needle and syringe programs (in accordance with the National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008 Implementation Plan and Strong Spirit Strong Mind: Western Australian Aboriginal Alcohol and Other Drugs Plan 2005 – 2009).
3 A perceived advantage of this WA exchange-based model is that it minimises inappropriate disposal and thus reduces the time that might otherwise need to be invested in community relations around this issue. (WASUA reports a return rate of 97%.)
4 The term 'mobile' service in Western Australia refers to a service which follows a regular timetable of visits to specific locations.
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