Wendy Loxley

Cops, drugs and the community: establishing consultative harm reduction structures in two Western Australian locations

Abstract In Australia a police project incorporating four parallel trials was established to test a new model of illicit drug law enforcement, which gives greater emphasis to harm reduction at the community level. The project was based on a community-policing model developed in the United Kingdom and involved establishing a community based consultation structure comprising an implementation oriented Drug Action Team (DAT) and support oriented Drug Reference Group (DRG). Two of the trials operated in Western Australia: one in Geraldton, a small regional city; and the other in Mirrabooka, a large, diverse, metropolitan region within Perth. The project officers were faced with a number of challenges and had to develop strategies to overcome these. One of the important issues was the effect of continual changes in membership of DATs, and consequent fluctuating levels of enthusiasm and commitment. The size and composition of the DATs also had an impact on how they operated. Other issues included the management of different agency agendas and recognition that the project would only operate for a limited time. How the project officers dealt with these issues in their development of the DAT/DRG model and how the two trial sites incorporated harm reduction into illicit drug policing are presented and discussed.

Doing the possible: harm reduction, injecting drug use and blood borne viral infections in Australia

Most surveys show that, other than among men who inject drugs and have a history of homosexual contact, the prevalence of HIV infection among injecting drug users (IDUs) in Australia is about 2%. Rates of needle sharing have also declined greatly in the last decade, although the high prevalence and incidence of hepatitis C infection suggest that existing strategies have not yet brought this epidemic under control. Harm reduction has been the major Australian approach to the reduction of blood borne viral infections (BBVIs) in IDUs. Harm reduction strategies include needle distribution schemes, drug substitution therapies and education about safe administration practices. Importantly, with IDUs as with gay men, the infected and affected communities have been brought into partnership with health educators, researchers and policy makers. This paper will review Australias approach to the prevention of BBVI in IDUs and the effectiveness of current strategies. I will argue that while HIV/AIDS among heterosexual IDUs appears to have been successfully prevented, international experiences of rapidly emerging epidemics demonstrate there is little room for complacency. Moreover, reducing the incidence of hepatitis C and hepatitis B among IDUs remains a major challenge.

‘Sluts’ or ‘Sleazy Little Animals’?: Young People's Difficulties with Carrying and Using Condoms

Qualitative data from a Western Australian study of sexual behaviour in young people were used to describe difficulties experienced in carrying and using condoms. Both men and women were concerned for their sexual reputation if they carried condoms, although this was more of a problem for the women than the men. However, these fears were not matched by the attitudes of the opposite gender: in general, there was less negativity about condom-carrying than was feared. Many of those who described using condoms had experienced condom failure and other difficulties, and it appeared that they were unfamiliar with the correct way to use condoms. It is suggested that many of these barriers to condom use can be removed with appropriate education and information strategies.

Bingeing on psychostimulants in Australia: do we know what it means (and does it matter?)

Bingeing on psychostimulants, considered to be the most hazardous pattern of use, is usually characterised as repeated use over several days involving the administration of high doses by injection. Drug users recruited from a variety of sources were asked what they meant by bingeing. Both qualitative and quantitative analyses were undertaken. The dimensions of bingeing are reported. Opportunity, drug related cues and psychological factors operate as cues to commence and cease bingeing. Polydrug use and injecting drug use appear to be salient characteristics of drug users who binge. It is concluded that bingeing is a more complex and variable phenomenon than previously thought, and should be considered in developing harm reduction strategies.

Medications used in overdose and how they are acquired - an investigation of cases attending an inner Melbourne emergency department.

Objective: This study aimed to investigate which categories of medication are most commonly implicated in overdose, to compare this information with prescription data and to explore how the medications used in overdoses are typically acquired.

The Australian Study of HIV and Injecting Drug Use. Part I: Prevalence for HIV, hepatitis B and hepatitis C among injecting drug users in four Australian cities

The objective of this study was to assess differences in HIV, hepatitis B and hepatitis C seroprevalence among injecting drug users (IDU) in four Australian cities. Eight hundred and seventh-two current IDU were recruited in approximately equal numbers from each of Adelaide, Melbourne, Perth and Sydney, and interviewed individually using a structured questionnaire. Fingerprick blood samples were taken from the majority of respondents, and tested for past exposure to the three viruses. HIV and hepatitis B and C raw seroprevalences were compared across cities, and comparisons were made of age-standardized seroprevalences for hepatitis B and C. Three percent of all respondents were HIV seropositive; 19% (23% age-standardized) were hepatitis B seropositive and 55% (60% age-standarized) were hepatitis C seropositive. There were general city differences and gender, sexual preference and treatment status group differences between the cities. Sydney respondents had the highest risk of infection for all three viruses in all comparisons. This was particularly striking for HIV among non-heterosexual men. Various explanations for the findings were considered, including city differences in demographic and drug use variables, underlying patterns of risk behaviour, and period/cohort effects. It was concluded that none of these explanations appeared to fit the pattern of findings, and that these probably represented true underlying differences in size of pools of infection. The reasons for this, however, cannot be ascertained from this study.

Characteristics of medication overdose presentations to the ED: how do they differ from illicit drug overdose and self-harm cases?

Background Medication overdose accounts for >80% of hospital presentations for self-harm. Previous research has identified typical characteristics of medication overdose cases; however, these cases have not been well differentiated from other similar presentations, namely (1) illicit drug overdose and (2) self-harm by means other than overdose. Method A 12-month audit of medication overdose cases (both intentional and unintentional) attending the emergency department (ED) of a major metropolitan public hospital in Melbourne, Australia was conducted. Comparison was made with patients attending for illicit drug overdose or for self-harm by means other than overdose. Results Medication overdose cases (n=453) showed a broadly comparable profile with those found in earlier studies (predominantly female gender, aged in their 30s and referred for psychosocial assessment). A similar though not identical profile was noted for self-harm cases (n=545). In contrast, patients attending for illicit drug overdose (n=409) could be characterised as male, in their 20s and not referred for psychosocial assessment. Illicit drug overdose cases were more likely than either the medication overdose or self-harm cases to be triaged in the most urgent category (19.3, 3.8 and 3.9% respectively), suggesting a high level of acuity in this group. However, the illicit drug overdose group on average spent less time in the ED than medication overdose patients, and were less likely to require hospital admission. Conclusion On both demographic and treatment variables, patients attending the ED following a medication overdose more closely resemble those attending for self-harm by means other than overdose than those attending for illicit drug overdose.

YOUNG PEOPLE, ALCOHOL, AND DRIVING IN TWO AUSTRALIAN STATES

Road traffic accidents are the single largest cause of death in Australia among people aged 15-24. The proposition that a broadly based deterrence measure, such as random breath testing (RBT), would be sufficient to change the behavior of young drivers was tested in a comparison of young drivers in New South Wales (NSW), which has had RBT for 6 years, with young drivers in Western Australia (WA), where there was no RBT. The results demonstrated that NSW young drivers were less likely to drink and drive and more likely to believe their peers would disapprove of drink-driving than were their counterparts in WA. It was concluded that RBT had altered the drink-driving behavior and possibly the beliefs about drink-driving of young people in NSW.

Deterrence and prevention of alcohol-impaired driving in Australia, the United States, and Norway

A sample of 4,316 drivers from Norway, the United States, and Australia responded to national surveys probing individual, social, and legal factors that contribute to control of alcohol-impaired driving. These factors are considered within the framework of general deterrence (control in response to a fear of punishment) and general prevention (control through internalization of moral inhibitions and socialization of preventive habits). Striking differences in social norms, attitudes, and behaviors surrounding drinking and driving in the three countries suggest that Norway has progressed farthest toward general prevention, whereas Australia relies more on general deterrence. Both general deterrence and general prevention are relatively weak in the United States.

Sex, gender, drugs and risk: The Australian study of HIV and injecting drug use1

Abstract The Australian Study of HIV and Injecting Drug Use (ASHIDU) is a multi-city study of 872 injecting drug users (IDUs), recruited from treatment and non-treatment sources. Questionnaire data and seroprevalence for HIV, hepatitis B and hepatitis C were collected during 1994. This paper investigates Very Risky Sexual Behaviour (VRSB), which is defined as having had penetrative sex with more than one partner, and inconsistent use of barrier protection, during the month prior to interview. Predictors of risk for women and men were analysed separately. It was found that VRSB in women was independently predicted by using tranquillisers before the last sexual encounter (O.R.=5.7), being single (O.R.=2.9), being non-heterosexual (O.R.=2.7), not being in drug treatment (O.R.=2.3) and being employed (O.R.=1.9). VRSB in men was predicted by having a non-regular last sexual partner (O.R.=5.5), being HIV positive (O.R.=4.4), using tranquillisers during the month prior to the interview (O.R.=2.5), the last sexual partner being an IDU (O.R.=2.5) and being younger. These gender differences are discussed in the light of harm reduction strategies to minimise the spread of sexually transmissible diseases in IDU. It is concluded that different strategies will be needed for different sub-categories of IDU.