Indigenous Law Bulletin
by Chris Lawrence, Sarah Hopkins and Timothy Moore
On the 31st of January 1999, in the lead up to the NSW election, the State’s then Minister for Health and Aboriginal Affairs, Dr Andrew Refshauge, ordered the suspension of Redfern’s needle and syringe exchange outreach service, which was located in Caroline Lane.
The Caroline Lane exchange saw over one hundred and fifty clients per day and provided about 38,000 pieces of clean equipment per month for the prevention of HIV, the virus that causes AIDS, and Hepatitis C, a virus that can cause significant liver damage and lead to liver cancer. It provided services mainly to local Aboriginal people: 80% of all clients were from Redfern and 85% were Aboriginal.
The suspension of the service was apparently prompted by the appearance in Sydney’s Sun-Herald newspaper of numerous photographs and several pages of stories relating to injecting drug-use sourced in Redfern. On 30 January 1999, the front page displayed a photograph of a Caucasian and other non-Indigenous young people injecting close to where injecting equipment was being distributed by the Caroline Lane exchange. These newspaper articles did not mention that Aboriginal people were injecting in the area.
The suspension of the needle exchange triggered a debate within the Indigenous and non-Indigenous Redfern communities both about the value of needle exchanges generally and about the appropriateness of the Caroline Lane exchange’s location. Community-based agencies and organisations became key contributors to these discussions because the Minister for Health had stated that the service would not be resumed until consultation with the community had taken place and because they provided venues for that consultation and debate. Drug users in the area were not consulted.
A Ministerial review of the exchange found that the exchange had been operating within its guidelines and had performed creditably in difficult circumstances.
Many people in the Australian community are not aware of the potential for a rapid spread of HIV among injecting drug users. This is due in part to the success of needle and syringe exchange programs and drug-user education. The impact of an epidemic in Indigenous and minority communities should not be underestimated. Throughout the world, Indigenous and minority communities show higher rates than the general population of HIV and Hepatitis C infection. In the USA, the Afro-American community makes up 12% of the population but accounts for 48% of new AIDS cases. AIDS is having a significant and long-term impact among Indigenous communities in places as diverse as Inuit and Native American North America, Honduras and North-East India. The impact of the reduction in HIV prevention services on the Indigenous community Redfern and beyond has yet to be fully evaluated. However, a HIV epidemic could be rapidly generated through a combination of reduction in access to needle exchange services and increases in cocaine use as is seen in Redfern. Many Aboriginal commentators in the Redfern and broader Indigenous communities ignored the fact that it is local community members that made up the bulk of the service’s clients and that it was in response to local need that the service was established in the first place. These community members are often highly mobile, moving around the State and the country and sometimes going in and out of prison on a periodic basis.
The community discussions have also revealed that health and community workers are not properly trained in cross-cultural awareness. Although many community workers had an understanding of transmission issues for HIV and Hepatitis C, many did not have an awareness of the cultural issues specific to Indigenous communities, nor of the translation of these cultural issues in relation to injecting drug use. Within Indigenous communities, the cultural significance of practices like sharing may be difficult for people to avoid when equipment is in short supply. In the same way, if people learn injecting in prison and equipment is in short supply, they may revert to prison practices.
As many community workers are not specialists in drug and alcohol issues, they were largely unaware of the differences between heroin and cocaine injecting practices and were not aware that relapse during drug dependency treatment is more often the rule than the exception. Nor were they aware of the complex relationships between drug use, hopelessness and depression, homelessness, social stigma (eg: sexuality, race, gender), childhood trauma, family and social background. This lack of awareness led to a misunderstanding by community workers and the general community about the effect that the suspension of the service, and solutions to the drug problem, have on wider issues.
Health workers and other community workers had often not received appropriate training in law and policy relating to drug use. For instance, some workers were not aware that it is legal to carry a syringe, either new or used. Because of this, some clients avoided certain health services because of fears about confidentiality. Confidentiality is not merely a courtesy for health services. It is a statutory requirement under medical ethics and funding guidelines. Policy reform and program innovation can play an important role in reducing the harm associated with drug use. The fact that it is legal to carry needles and syringes encourages drug users to use safe injecting practices and empowers them to take an active role in the prevention of blood-borne virus transmission.
In order to gain a fuller understanding of the issues involved, it is recommended that community groups seek advice, assistance and education on Drug and Alcohol as well as legal issues from organisations that are regularly engaged in this field. The AIDS Council of NSW and the Australian Federation of AIDS Organisations has been working with groups in this area to try to raise awareness of the issues.
With raised awareness in the community around issues of HIV and Hepatitis C risk, a range of proposals has been put forward. For instance, that detoxification clinics be compulsory or that the exchange operate on Redfern Street. Only those proposals for which there is some evidence showing their effectiveness should be developed. Poorly developed proposals could not only fail to stem a HIV epidemic in the Indigenous community but could have a counter-productive effect.
Although Australia's record of harm reduction and HIV prevention has been a benefit to all Australians, it is possible that a future epidemic of HIV among Australia's Indigenous communities emerging some years from now could be traced to early 1999 and the closure of this service. This would be the saddest evaluation of all.
Chris Lawrence is a Nyoongar man from Western Australia who is currently Aboriginal Men's Worker with the AIDS Council of NSW (ACON). Sarah Hopkins is vice-president of the NSW Council for Civil Liberties and is a solicitor at the Sydney Regional Aboriginal Corporation Legal Service. Timothy Moore has worked in harm-reduction and HIV prevention for more than ten years and is the Drug Policy Worker at Redfern Legal Centre.
 Centre for Disease Control website in Atlanta: ‘Populations at risk: minority and Native American communities’ @ < <http://www.cdc.gov/> >.
 Cocaine is often injected more than ten and as often as twenty times in a day whereas heroin is usually only injected a few times in any given day.
 The Report of the Inquiry into Aboriginal Deaths in Custody observed that while non-Indigenous prison inmates are often imprisoned for reasons relating to their pre-existing drug-habit, Indigenous inmates are often initiated to intra-venous drug use only after being placed in custody. Injecting equipment is not available in prisons, and sharing is common.