THE NEEDLE-AND-SYRINGE PROGRAM HAS TO EXPAND AND ADJUST

As the seemingly intractable problem of attracting bi-partisan or
cross party political support for national responses to a range of
serious and complex issues we face today fills the media, it is worth
stopping to recognise that for over 20 years a very important response
to HIV prevention in this country has been providing an extraordinary
return to the community. A study released last week showed that the
investments in needle and syringe programs were yielding a twenty
seven fold return in health, productivity and other gains. It also
meant there were over 30,000 people protected from acquiring HIV and
almost 100,000 from acquiring hepatitis C. Yet it had to overcome
widespread controversy at its inception to yield this return today.

In the mid 1980's as hysteria about homosexuality and AIDS began to
dominate the public debate there was an increasing sense of foreboding
amongst some public health and community advocates on the impact HIV
could also have on people who inject drugs. The international reports
on the growing number of injectors who were testing positive to HIV
meant that Australia had to implement strategies and programs very
quickly to ensure the same disaster that was unfolding overseas for
injectors, their families and sexual partners didn't happen here.

This was the genesis of the needle and syringe program in Australia.
Led by a coalition of drug users and health workers a needle and
syringe program began as an act of civil disobedience in Darlinghurst
in 1986. There is no doubt that some risked their careers and much
more by taking such a decision, but with the support of a small band
of forward thinking health officials and police officers, and most
importantly the courage of some important figures in Canberra, the
needle and syringe was not only born but introduced around the country.

The notion of legally giving needle and syringes to people injecting
illegal drugs was of course not supported by everyone, including some
in the health, political and media spheres. Today their fears have
proven to be unfounded.

What is striking is the level of public support for the program. The
largest regular survey on drug use issues we have, the National
Household Survey on Drugs, now records public opposition to the
program at less than 20%. The Hawke, Keating, Howard and now Rudd
Governments, as well as a myriad of state and territory governments of
varying hues over the past 20 years have all lent their support to the
program. For some this was in the face of strident opposition. A truly
admirable achievement based on evidence, common sense and humanitarian
grounds.

For many people drug use is a transient phase in their lives. For some
it becomes an overwhelming presence that at times leaves room for
little else, but most drug users move on with the help of treatment,
support or of their own volition. As they move on what possible sense
would it have made to have greatly increased their likelihood of
becoming HIV or hepatitis positive whilst using drugs? The answer is
none. The reality is that despite our best efforts there will always
be people who use drugs, and for a variety of reasons. During this
often brief period for many it is critical that their health is protected.

Today, Australian officials rightfully boast about the very low rate
of HIV infection rates amongst injectors. The problem is that this
self congratulatory behaviour can lead to a delusion that the needle
and syringe program has done its job, when it hasn't. The program
needs greater investment to adjust, expand and move to meet the
changing trends in drug use, and to help slow the hepatitis C
epidemic; it needs to be made far more available and accessible with
governments needing to look at removing the unnecessary barriers that
were put in place when the program was introduced at the height of
controversy.

In particular prisons are a real blind spot in Australia's response to
HIV and hepatitis C. Prisons have over 30,000 people pass through
their gates each year, often for less than 6 months, much higher
hepatitis C rates than we see in the broader community, extremely
risky injecting practices with at time dozens sharing the same old
needle and syringe repeatedly, a high level of sexual assault and
other violence and a large number of people with drug problems.

After leading the world for so long on preventing HIV, no prison in
Australia has a needle and syringe program operating, or has even
trialled one. This is despite such programs already operating in other
countries including Spanish, Swiss and even Iranian prisons.

The opposition in Australia to a prison needle and syringe program
generally focuses on two areas. First, just stop the drugs getting in.
The reality is that there probably isn't a prison in the world where
drugs are unavailable. Huge numbers of people go in and out of prisons
every day other than prisoners, such as staff, contractors, legal
officials and visitors. Drugs are so easy to hide that it would
require a full body cavity search every man, woman and child every
time they entered a prison to find them. The second strand of
opposition is the understandable fear by staff. Again, the reality is
that there are already many needles and syringes in prisons, they are
just hidden throughout the prison. Addressing staff fear is vital but
surely this is not beyond a country with the needle and syringe
program record of Australia.

Australia has one of the most effective HIV prevention programs in the
world it's just a pity that our humanitarian and common sense
approach to HIV hasn't extended across the prison walls yet.