Even in the context of the relatively good access to harm
reduction services in Australia, the principle reasons for people who inject
drugs to re-use syringes relate to the convenience of services, the stigma of
drug use, a fear of repercussions and other contextual factors. No participant
reported sharing equipment as a choice – if sterile equipment had been readily
available at the time they needed it, they would have preferred to use it.
Dr Angella Duvnjak of the Australian Injecting and Illicit
Drug Users League (AIVL) presented these findings to the 24th
International Harm Reduction Conference in Kuala Lumpur, Malaysia this week. (They have also been published in a recent report). A
unique aspect of the study is that it was planned, conducted and analysed by
peers of those being researched (current or former injecting drug users). As
the research is both peer-led and qualitative, it can add the voice of drug
users to the question of why re-use of injecting equipment occurs.
Australian surveys consistently suggest that around one in
six people who inject drugs have used a syringe that another person has used
(often referred to as ‘sharing’ equipment). Sexual partners are especially
likely to re-use each other’s equipment.
To better understand why, the peer researchers recruited 50
people who inject drugs to take part in focus groups in four Australian cities
in 2014. Different groups were held with people who inject heroin, methadone,
amphetamines and steroids, as well as a group of people who had injected in
prison. The groups included people who lived in rural areas and travelled to
the city.
Although Australia has, compared with many countries, an
extensive network of needle and syringe exchanges, there remained barriers to
access. The locations and opening hours of exchanges didn’t consistently meet
people’s needs. The lack of coverage at weekends and over public holidays meant
that equipment was more likely to be re-used then.
Opening times could be unclear or could change without
notice, although many people had to travel a considerable distance to go to a needle
and syringe exchange.
“Say the place is
shut, doesn’t open ‘til 12.30pm on Wednesday or whatever it is, we don’t have a
vending machine, or whatever. So I mean I’ll reuse my own.”
There were variations between services in relation to the
specific types of equipment that were stocked and how much could be taken at
one time. These restrictions were felt to be counter-productive:
“With that Civic one, like, they tell you are
only allowed six a day, but some days I have more, might have eight or nine
shots a day…..they’re telling me how many shots I can have a day and that
doesn’t work out.”
“Why do I have to go
in every day to satisfy them? Why would I ask for more than six if I don’t need
them?”
When a variety of services were available, this helped
prevent incidents of re-use. Vending machines and pharmacies were important
back-ups, especially at night or the weekend. Nonetheless both had limitations,
with the number of locations being more limited than participants would like.
Some vending machines had a reputation for breaking down.
Some participants spoke of a fear of being discovered or
exposed as a person who injects drugs. People who had previously been
imprisoned were especially likely to be concerned about this, which discouraged
them from carrying or stockpiling injecting equipment.
“I’d rather use my fit
at home than go to the city market chemist (where they call security) and buy a
pack. I would rather use a dirty fit at home.”
Participants feared the consequences of ‘the authorities’
discovering that they use drugs. Women with children, people receiving opioid
substitution therapy and aboriginal participants were especially worried.
“It’s not the look
that fears me, it’s the fact that they then can talk to somebody and that’s my
methadone cut off and if I don’t have my methadone, I can’t be a mother. I
can’t go to school. My ex-husband will get my kids and just this cascade of
other shit that I don’t want to have to deal with.”
Stigma was a major aspect of people’s stories of re-using
equipment. For example staff at pharmacies could make people feel
uncomfortable:
“Some won’t touch your
hand to take your money off you or anything like that.”
Stigma operated in a different way for those who injected
performance and image enhancing drugs. They were often reluctant to use needle
and syringe exchanges that they felt were aimed at people they didn’t want to
identify with.