Gary Reid

Drug Treatment Services for Ethnic Communities in Victoria, Australia: An examination of cultural and institutional barriers

Under-representation of ethnic minorities at drug treatment services represents under-utilisation rather than a lower need. To explore barriers to drug treatment among ethnic communities we undertook a comprehensive review of international and Australian literature to identify problems their members experience upon the discovery of illicit drug use in their community, how drug treatment is addressed and challenges for improved drug treatment outcomes. The concepts and themes derived from the literature were then compared with our research findings from key informant interviews and consultations with non-illicit drug-using spokespersons from eight ethnic communities in Victoria, Australia. Intense shame and loss of face linked to illicit drug use was common in ethnic communities and as a consequence seeking help for drug treatment was fraught with difficulties. Accessing drug treatment services often occurred following a crisis, but a sense of despair and confusion often prevailed owing to a lack of knowledge of available assistance. Even when treatment services were accessed most key informants and ethnic communities viewed them as culturally insensitive, inflexible and with language barriers that obstructed the flow of effective information. Understanding of the ethnic family ethos was of pivotal importance but frequently ignored by treatment services, contributing to the exclusion of ethnic communities from appropriate assistance. Ethnic communities need to be assisted to participate in drug issue discussions and community development strategies in order for their utilisation of drug treatment services to be improved.

Vulnerability among Vietnamese illicit drug users in Australia: challenges for change

A broad range of vulnerabilities, risk factors and challenges for change were examined in order to better understand why ethnic Vietnamese have the highest profile in Australia in relation to illicit drug use. A literature review of vulnerability and risk factors experienced by ethnic Vietnamese people in Australia was conducted. Emerging themes and concepts were tested against the 1996 Australian Census (Victoria), databases specific to illicit drug use, and the outcomes of key informant interviews and community consultations. Vietnam-born Australians are the third largest ethnic community in Australia. Due to high unemployment, poor English proficiency, experiences of racism, social and economic difficulties, inter-generational conflicts and acculturation, the ethnic Vietnamese community has become vulnerable to involvement with illicit drug use and distribution. Addressing drug problems among the ethnic Vietnamese community in Australia is hampered by a lack of structured, appropriate education and employment programs, biased media reporting and poor utilisation of drug treatment services. Socio-economic disadvantage and level of exclusion from the legitimate economy heighten involvement in illicit drug use and its associated harms.

The need for dialectical models as shown in the response to the HIV/AIDS epidemic

Argues that strong social analysis can make a large contribution to understanding and fighting HIV/AIDS plus other infective diseases. Contends a global perspective is necessary to rethink our approach to infections as, globally, the virus seems to be strengthening, generally. Describes, through case studies, the transition of HIV outbreaks in South Africa, Eastern Europe, Russia, and Indonesia. Makes the case that HIV/AIDS is deeply tied up in fundamental structure and processes.

Drug offending and criminal justice responses: practitioners' perspectives

Abstract This paper describes the perspectives of 35 senior criminal justice professionals from Melbourne, Canberra and Sydney who were interviewed in 1998/99, as part of a much larger study that examined illicit drug issues in the context of a multicultural community. Key informants worked across a range of areas within the criminal justice sector—national intelligence, inter-agency drug task forces, state and federal police, corrections, juvenile justice, judiciary, and academic—each observing illicit drug issues from different perspectives. Despite being from different areas within the criminal justice sector there were many similarities in perceptions about illicit drug use and current policy approaches to the problem. Many had private views that were at variance with the policy position adopted by their agencies. The majority of those interviewed believed that the response to drug users—many of whom also sell drugs—should primarily be one of health, and most were in favour of imaginative and liberal approaches designed to minimise the harms associated with illicit drugs.

Ethnic communities' vulnerability to involvement with illicit drugs

In this article, socio-economic and cultural factors which heighten vulnerability to involvement with illicit drugs and disproportionately impact upon ethnic minority communities are described. The concepts and themes derived from a review of international literature (mostly from the USA and other English-speaking nations) on factors associated with vulnerability to illicit drug use in ethnic minority communities worldwide were compared with the outcomes of our own investigation into the involvement of ethnic communities in Victoria, Australia with illicit drugs. Several factors which increase vulnerability to illicit drug use were identified in the literature review; our research showed that the same determinants are at work among ethnic minority communities in Victoria. These factors are high unemployment, poor proficiency in English, poor access to education and lower educational attainment, inter-generational conflict, acculturation issues and peer pressure. These factors can be distilled into a more ...

Advocacy for harm reduction in China: a new era dawns.

BACKGROUND Chinas initial response to drug use and HIV was largely ineffective but has improved with recent government endorsement of harm reduction interventions. This paper examines the views of senior key informants inside China who articulated core needs and objectives for the development of a harm reduction advocacy strategy. METHODS Thirty-nine key informants (KI) were interviewed, representing 19 stakeholder bodies selected from the Chinese government public health sector, public security sector, international agencies such as WHO, UNODC and UNAIDS, and international non-government organisations. RESULTS The concept of harm reduction is widely understood and considered valid. Support for harm reduction is increasing, but KIs perceived an imbalance between the rapid expansion of methadone maintenance treatment programs over needle and syringe programs and other interventions. Challenges for harm reduction identified by KIs included: policy inconsistencies; lack of skilled resources, training programs and technical capacity; poor coverage of interventions; and gaps in the sharing of information. KIs suggested numerous ways to strengthen the capacity of the government and communities to reduce drug related harm. DISCUSSION Increased acceptance of harm reduction in China, particularly among public security, implies a new level of optimism towards addressing the HIV epidemic among drug users, and parallels an impressive expansion of harm reduction interventions. Nevertheless, scaling up a response to the ongoing dual epidemic of drug use and HIV remains an enormous challenge. With appropriate technical education and training, ongoing advocacy, and a cohesive, coordinated multi-sectoral effort, the capacity of the government and community to adopt, support and promote measures to reduce HIV and other drug related harm would be markedly strengthened.

Ethnic Based Differences in Drug Offending

There is a perception in Victoria that some ethnic groups are more heavily involved in illicit drugs than others. The published police and prison statistics appear to support this view. The paper discusses why published statistics show an increase in drug offending by people of Vietnamese birth, describes some of the outcomes of current criminal justice responses to the illicit drug problem in Victoria, and identifies differing offending patterns between drug offenders of “Asian” and “non-Asian” backgrounds. Court and Juvenile Justice key informants’ perceptions of the reasons young “Asian” people become involved with heroin is also briefly discussed.

The long winding road of opioid substitution therapy implementation in South-East Asia: challenges to scale up

The South-East Asia Region contains an estimated 400,000-500,000 people who inject drugs (PWID). HIV prevalence among PWID is commonly 20% or higher in Indonesia, Thailand, Myanmar and some regions of India. Opioid substitution therapy (OST) is an important HIV prevention intervention in this part of the world. However, key challenges and barriers to scale up of OST exist, including: pervasive stigma and discrimination towards PWID; criminalisation of drug use overshadowing a public health response; lack of political will and national commitment; low financial investment; focus towards traditional treatment models of detoxification and rehabilitation; inadequate dosing of OST; and poor monitoring and evaluation of programmes. Our review of local evidence highlights that OST can be successful within the Asian context. Such evidence should be utilised more widely to advocate for policy change and increased political commitment to ensure OST reaches substantially more drug users. Significance for public health Several countries in the World Health Organization South-East Asia Region can be commended for introducing opioid substitution therapy (OST) to address the ongoing HIV epidemic among people who inject drugs (PWID). Local evidence shows OST is an effective drug treatment approach in the Asian context given sufficient technical and institutional support. However, despite much progress, the number of OST dispensing sites and recipients remains totally inadequate in terms of impact upon the current HIV epidemic among PWID. Ongoing advocacy is needed if countries are to achieve the WHO’s target of 40% of PWID being dosed with OST. Greater political commitment a strengthened policy environment, capacity building for OST clinics, lessening the criminalisation of drug use and promoting a public health response will give many more PWID access to OST and slow the advance of the HIV epidemic.

A methodology for sampling and accessing homeless individuals in Melbourne, 1995–96

A methodology for sampling homeless populations in inner Melbourne was developed to study their health status and prevalence of tuberculosis. This paper describes the design, development and implementation of the project. The results of health status and tuberculosis analysis are published elsewhere. Involvement and interaction with local service providers and agencies to homeless people was central to the project throughout. A definitional construct of homelessness was developed, drawn from local and overseas literature and contemporary local experience. The study?s aim was to obtain a representative sample of homeless individuals in various levels of accommodation and a convenience sample of those who were unaccommodated (streets and parks). A comprehensive sampling frame of accommodation options was constructed from available databases, and systematic sampling applied to produce a sample of 396 beds, from which 284 participants were enrolled. Convenience sampling of unaccommodated homeless individuals produced 100 participants. All agreed to undergo a comprehensive questionnaire, blood and Mantoux testing, the latter being completed successfully in 94%. Commonsense, cultural sensitivity and a non‐threatening approach were critical to the success of the project and the security of the field workers. The methods described attempt to address recognised difficulties of sampling from homeless populations and should be reproducible both in the future and elsewhere. Potential for selection bias remains the main threat to validity, which the described methodology combined with adequate resources should help to address.