Some examples of good practice that were noted in the course of this study are set out below.

Partnerships and advocacy
Cultural awareness training in the mainstream
Role of drug user support and advocacy groups
Outreach and mobile services
Indigenous friendly services
Enhanced NSP services
Extended hours
Vending machines
Peer services
Reaching young people
Choice

Partnerships and advocacy

Over the past five years or so the Aboriginal Health and Medical Research Council (AH&MRC) in New South Wales has been active in examining issues relating to hepatitis C infection and injecting drug use and in providing leadership in developing responses to BBV infection. The AH&MRC played a key role in conduct of the 2004 NSW research project on BBV needs and services (see Appendix C to this report), and was subsequently able to obtain funding for two new staff positions relating to workforce development and harm minimisation. It has established working relationships with organisations such as NUAA (NSW Users and AIDS Association) and has undertaken an advocacy role with national bodies such as Ministerial Councils and IASHC.

NACCHO affiliates in some other jurisdictions have taken on similar roles – for example in relation to partnerships with other relevant agencies and organisations, and hepatitis C training and awareness-raising for the Indigenous health workforce.

Cultural awareness training in the mainstream

In 2007 Turning Point, a Melbourne drug and alcohol agency and NSP outlet, undertook cultural awareness and safety training for its staff, working in partnership with VACCHO.
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Role of drug user support and advocacy groups

AIVL, the national drug user advocacy body, has played a key role in the establishment and operation of The Connection, a peer-based drop-in and support service in Canberra for Indigenous IDUs.

In Cairns the Mix-Up peer education project conducted by the Queensland organisation QuIHN has been successful in reaching numbers of Indigenous IDUs. Drug user support groups in other places, such as NAP in Darwin, have effective links with both Indigenous and non-Indigenous IDUs, which they use to promote peer education activity and awareness of issues such as safe injecting.

Outreach and mobile services

It is widely accepted that mobile and outreach NSP services are an effective way of facilitating access by marginalised or hard-to-reach groups, and numbers of the stakeholders consulted during this study saw such methods as an important way of improving Indigenous IDUs' use of services. In Adelaide the Nunkuwarrin Yunti medical service has for some years operated a daily outreach service targeting homeless and other disadvantaged Indigenous IDUs in the inner city, as well as a fixed site service. At Redfern in inner Sydney – which is unusual in being both a centre of Aboriginal population and an area known for high rates of illegal drug use – REPIDU similarly offers both a fixed site and an outreach service. The mobile NSP service operated in Perth by the WA AIDS Council reaches groups of Indigenous IDUs at some of the suburban locations it visits. In the Riverland in South Australia an NSP service has been incorporated into a mobile primary health service.

Indigenous friendly services

The report refers to various approaches that NSP services can take in an effort to ensure that they are perceived as friendly to and supportive of Indigenous clients. One is by display of relevant materials and symbols, use of appropriate colours, graphics and the like. The South Court Primary Care NSP in western Sydney, for example, flies the Aboriginal flag.

The study also pointed to the usefulness of offering NSP services at sites that are already identified in some way with the Indigenous community or regarded positively within that community. Examples quoted were the Youthlink service in Cairns, Clinic 34 in Alice Springs and the Sobering Up Centre in Port Augusta.

Enhanced NSP services

Some stakeholders argue that enhanced NSP services which offer IDUs additional health and referral services, and possibly 'drop-in' facilities, are useful in improving Indigenous access – both because of the direct benefits they offer to clients, and because more holistic services of this kind may help make the NSP more acceptable to the wider Indigenous community. MINE in inner Melbourne and South Court Primary Care in western Sydney are examples of NSPs offering access to broader health services. The range of health services provided by the Nunkuwarrin Yunti AMS in Adelaide (including a weekly liver clinic) means that in practice, although not funded as such, it too offers an 'enhanced' service

Extended hours

Given that drug injecting frequently occurs at night or at the weekend, limited NSP hours were often mentioned as an access barrier by the Indigenous IDUs consulted during this research. Community pharmacies and in particular Emergency Departments are (apart from friends and acquaintances) the most common sources of clean equipment outside normal business hours. However, some primary or other secondary NSP outlets do offer evening or weekend services; examples encountered during this study included the Sobering Up Centre in Port Augusta, REPIDU in Redfern (Sydney), WAAC and WASUA in Perth and the Health Information Exchange in St Kilda (Melbourne).

Vending machines

Machines which automatically dispense packs of needles and syringes (usually for a small fee) provide a means of overcoming some of the barriers to Indigenous NSP access, including the fear and embarrassment which may deter people from approaching NSP workers. They can also, of course, provide considerably increased access out of hours. New South Wales has a substantial network of vending machines, and there are machines sited at Community Health Centres in the main town centres in the ACT. Queensland Health has set up dispensing machines in eight regional locations, and there are small numbers of machines currently in use in some other jurisdictions.
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Peer services

The peer service most often referred to during this research was The Connection in Canberra. The Connection is not an NSP outlet, but it offers a supportive drop-in environment to IDUs (mostly but not exclusively Indigenous) and is widely seen as a valuable element in achieving harm reduction objectives in the ACT. The Nunkuwarrin Yunti NSP outreach operation in Adelaide, also, is a peerbased service in that it is staffed mostly by Indigenous workers.

It was often observed that some Indigenous IDUs act as intermediaries in collecting clean injecting equipment that they pass on to others. It would clearly be useful if this informal system of peer support and education could be reinforced; this is in fact one of the objectives of the 'Mix Up' project being undertaken in Queensland by the user support organisation QuIHN.

Reaching young people

One of the strongest themes to emerge from this research was the importance, and the difficulty, of ensuring that young and possibly inexperienced Indigenous IDUs have access to services that may help them avoid HCV infection. There do not appear to be many current initiatives that deal directly with this issue. In Darwin, however, Hoops 4 Health is a project that uses basketball activities as a way of engaging young people and conveying messages about hepatitis C issues and risks. The Gulwan Gugan youth service in Canberra provides an outreach NSP service and The Connection, also in Canberra, reaches a relatively young age group.

Choice

Ensuring that Indigenous IDUs have some choices or options about how to obtain sterile injecting equipment was identified as an important enabler. Even a small town like Carnarvon in Western Australia can offers IDUs a number of options; needles and syringes are available there from a service operated by Population Health, from the hospital Emergency Department and from a community pharmacy. The Aboriginal health service in Carnarvon is authorised to operate as an NSP outlet and the point was made that, although the volume of equipment that it dispenses is small, its participation in the NSP has a symbolic value in endorsing harm reduction principles.