By Erin Snelgrove

The final public consultation on the installation of an Automatic Dispensing Machine to provide sterile drug injecting equipment and disposal packs outside the Redfern Health Centre saw avid supporters, concerned residents, other local stakeholders and government representatives wrangling with what was the relative minutiae of rational public health strategy for some; and for others, the perceived assault on a neighbourhood continuing to work hard at self-improvement.

By all accounts, the meeting was markedly less volatile than prior meetings in the consultation process, but it hasn’t appeared to quell concerns about the Automatic Dispensing Machine (ADM), and has quite possibly exacerbated frustrations over government’s approach to community engagement. Less than one week later, with no mention made at the meeting, the ADM was installed.

The premise for the ADM is relatively straightforward: Human Immunodeficiency Virus (HIV) rates among injecting drugs users in the Redfern Waterloo area are three times the national rate, and Hepatitis C rates are 10 per cent higher than anywhere else in Australia. It’s a situation described by Dr Teresa Anderson, Chief Executive of Sydney Local Health District as being a major public health crisis that cannot be ignored.

Australia has long been at the forefront of the international public health response to the emergence of HIV/AIDS, and in 1987 passed legislation to enable legal distribution of needles, syringes and other injecting equipment to injecting drug users , developing a National Drug Strategy (NDS) with three interdependent strategies;

• Harm reduction: aiming to prevent anticipated harm and reduce actual harm to individuals and communities,
• Supply reduction: to disrupt the production and supply of illicit drugs and to control and regulate licit substances,
• Demand reduction: to prevent the uptake of harmful drug use through education and other prevention activities and to reduce drug use through treatment and rehabilitation activities.

Harm reduction strategies are underpinned by Needle and Syringe Programs to address the sharing of used injecting equipment, which is the primary manner in which blood borne viruses (BBV), including HIV and Hepatitis B and C, are transmitted. Providing both preventative and primary health services, Needle and Syringe Programs continue to play a vital role in Australia’s enviable reputation for comparatively extremely low rates of BBV.
According to a report commissioned by the federal government, Needle and Syringe Programs (NSPs) resulted in the prevention of an estimated 25,000 cases of HIV, and 21,000 cases of Hepatitis C among injecting drug users between 1991 and 2000. Savings to the health care system alone, in avoided treatment costs over a lifetime were estimated to be between $2.4 billion and $7.7 billion.

“Access and anonymity are essential.”
Jason, local resident, irregular Injecting Drug User, HIV and Hepatitis C positive

The first Automatic Dispensing Machine was installed in NSW in 1992 and there are now 150 in operation. Credited with accessing hidden and high-risk groups of Injecting Drug Users, including young people, women and irregular users, Automatic Dispensing Machines offer anonymous access to sterile injecting equipment for people who may not identify as having a drug addiction, or who may be unwilling to admit to having such. Most injecting drug users are able to go about their day-to-day business without being labeled, however once labeled, are often never quite able to completely shake off the associated stigma. In reality, the people who fit the commonly perceived stereotype of a ‘junkie’ – for example, a homeless, unemployed, hygienically challenged individual with bad teeth – are a minority in the drug using community . These individuals are likely to avoid engagement with services, and ADMs are considered both pragmatic and essential in reaching them.

Similarly, drug use is not confined to a nine-to-five schedule and services are diverse to accommodate the different patterns of user. The Redfern Automatic Dispensing Machine is in operation only when the Redfern Health Centre and pharmacy (offering needle exchange) directly opposite, are closed. For the most part that is after 9pm and on Sundays.

In 2010, the $9.8 million Redfern Health Centre (RHC) opened in the original Courthouse on Redfern Street. Designed to provide a central location for a range of community health, drug and alcohol, and mental health services as part of the NSW State Government’s long term plan for the Redfern Waterloo area, DA approval was granted in 2007 to operate an Automatic Dispensing Machine at the RHC entrance. It wasn’t until 2012 that Sydney Local Health District publically announced its plans for the ADM – a long time later in anyone’s book, let alone in a neighbourhood evolving as quickly as Redfern.

“We are of the opinion that an ADM on the main street… presents an image of Redfern that is at odds with the one that so many people have worked to develop.”
South Sydney Business Chamber

Stephanie Wood, in the Sydney Magazine (Issue 113, Sept 2012) described how “in only a few years, one of Australia’s most infamous areas has altered at an unprecedented pace. Today, it’s a place of fat real-estate prices, hipsters and the affluent, cafes and small bars, artisanal bakeries selling $7 loaves of bread, farmers’ markets, chic apartment blocks, designer dogs and all the joys of gentrification, spreading from Waterloo south of Phillip Street, across to Redfern Station and beyond to Eveleigh and CarriageWorks.” Despite this, the fact remains that the Redfern Waterloo community possesses unacceptably high levels of BBV, a fact that leaves the entire community – affluent, hipsters or not – in a precarious situation.

“What about our kids? What sort of message is it sending? It’s just going to bring crime back to Redfern and we don’t have a problem here anymore”
Anonymous

In 2009, an Automatic Dispensing Machine was installed on the corner of Albion and Crown Street in Surry Hills. A similarly regenerated area of inner Sydney, on a popular thoroughfare with a primary school a stone’s throw away and some of Sydney’s trendiest restaurants and cafes across the road, public objection was initially strong. Once installed, however, anxieties were dramatically reduced; there has not been one incident involving children, no increase in crime, and no public injecting or inappropriate disposal of used equipment.
Kate Reakes, appointed as Redfern’s Harm Minimisation Manager in late January, describes community education and support as key to changing people’s perceptions of harm minimization practices and in garnering their support. Facilitating the Automatic Dispensing Machine Implementation Working Group, established following consultations, Reakes provides information, education and support to local residents and business owners and reports a shift in attitudes already.

Designed with no advertising material or attractive attributes that might pique a child’s interest, there has been only one incident involving a child accessing an Automatic Dispensing Machine in Australia since the program began. The incident involved an injecting drug user holding his child up to the unit to press the button; the incident was captured by CCTV, and the Department of Family and Community Services followed up with the family.

Despite statistics telling us that access to clean needles does not result in an increase in crime nor does it create a ‘honey-pot effect’ where drug dealers are attracted to the area, some local residents and business owners remain fearful. There is a particular fear of infected syringes being used as weapons; public health rationale describes BBV as the danger, not the syringe.

Not surprisingly, addressing concerns around inappropriate disposal relies on providing opportunities for appropriate disposal. The Automatic Dispensing Machine has a sharps disposal unit attached, and the Redfern Sharps Waste Management Plan already includes safe disposal campaigns for users, community education, needle clean up hotlines and regular sweeps of the local area.

While there have been no reported instances of a member of the public becoming infected with a BBV after an injury from a discarded used syringe in Australia, the risk is real. As the recent pilot of sharps waste disposal bins at Northcott in Surry Hills has demonstrated (see opposite), this significant issue for government can be addressed through committed partnerships. For the approximately 25% of Redfern’s community who live in public housing properties, this move towards more proactive management of community sharps, particularly by Housing NSW, is sure to be welcomed. Community education also seems to be paying off with the Redfern Harm Minimisation Program receiving an enquiry from the strata of a private apartment complex in Waterloo regarding installation of a sharps disposal unit on its property.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”
World Health Organisation Constitution

In the end, the statutory obligation of the Australian government to address BBV in our communities through implementation of its National Drug Strategy and harm minimization policies won, with the Automatic Dispensing Machine in (partial) operation since February. As frustrating as the consultation process may have been, lets hope the evidence base supporting the ADM installation wins too. For all of us.

The Inner Sydney Regional Council for Social Development support harm minimization practice.

Originally published in Inner Sydney Voice, Issue 117, Autumn 2013