HIV Australia | Vol. 8 No. 1 | April 2010

By Jude Byrne

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Stigma and discrimination are at the heart of the blood borne viral epidemics among injecting drug users in this country.

Both the NSW Anti Discrimination Board Inquiry into Hepatitis C Related Discrimination in 2001¹ and the Senate Community Affairs Reference Committee on hepatitis C and the blood supply in Australia 2004² found that hepatitis C is a highly stigmatised condition, that hepatitis C discrimination is rife and that discrimination in relation to injecting drug users lies at the heart of both these situations. The current National Hepatitis C Strategy 2005-2008 also identifies stigma and discrimination as one of the areas for priority action. The strategy notes that ‘Eliminating discrimination against people with hepatitis C, or [who] are assumed to have hepatitis, is important both as a human rights issue in itself and because such discrimination affects the mental and physical health of [these] individuals’.³

It is clear to those of us working within our community that the implications and manifestations of the systemic violation of injecting drug users’ human rights is so far-reaching and invasive that the problem seems almost impossible to unravel. However, in the area of blood borne viral transmission there have been scientifically rigorous studies and peer reviewed research which prove that with the implementation of only two programs – Needle and Syringe Programs (NSPs) and Opiate Substitution Treatment (OST) - the lives of injecting drug users can be transformed. Even if this transformation was only in terms of our community ceasing to be the fodder for so many blood borne viruses (BBVs) – thousands of people would benefit. For over twenty years the Australian Injecting and Illicit Drug Users’ League (AIVL) and its peer organisations around the world have watched in horror, then in detached trauma, as country after country, state after state, refused to provide injecting drug users with the basic tools of survival. One cannot help but wonder if we have reached the biological phase of the ‘War on Drugs’. If we look beyond the African experience of HIV transmission where ‘nearly one third of new HIV infections are due to contaminated injecting equipment’,⁴ Australia could be seen by some to be in an enviable position. In this article I will argue that not only is our position nothing to be envied, but that the half hearted approach of our health system - which is always more about protecting the wider community than our drug users from bloodborne viruses - has left our most vulnerable citizens in an even more catastrophic position.

When we look to the situation overseas we see the heads of venerable institutions, such as the World Health Organization and UNAIDS, calling for an end to the human rights abuses that are occurring to so many of our peers in countries like Russia, China and Malaysia where NSPs and OSI are virtually unheard of. Michel Sidibe, the Executive Director of UNAIDS, is championing fundamental reforms of UNAIDS, with their work program now being related to priority areas. The UNAIDS ‘Joint Action for Results 2009-2011’ has nine priority areas, all of which overlap to some extent; but two of the nine directly speak to stigma and discrimination toward injecting drug users. They recognise that unless something is done in these areas the level of transmission and the concomitant social upheaval will not only continue but will increase. The two areas relating to stigma and discrimination are addressed by the following quotes:

‘We can prevent drug users from becoming infected with HIV: By making comprehensive, evidence informed and human rights based intervention accessible to all drug users..

We can remove punitive laws, policies and practises, stigma and discrimination that block effective responses to AIDS.By collaborating with civil society and all stakeholders to uphold non-discrimination in all efforts..’ ⁵

 

This document identifies the impact of the layers of social, legal, religious and medical barriers which are all heightening the burden of BBVs in the injecting drug user population. In 1998 anyone working in the field of injecting drug use and HIV had known for over ten years that where NSP was implemented it was having, and would continue to have, a positive impact on the rate HIV transmission among people who inject drugs. Despite the possibility of implementing life saving measures, in 1998 ‘the declaration from the UNs General Assembly Special Session on Drugs did not mention AIDS or include AIDS in the expert proceeding. A decade later the price of that omission is terribly clear’.⁶ ‘Those shaping the global response to drugs in 1998 did not mention the need for programs to provide sterile injection equipment ... These approaches were omitted from the 1998 declaration despite the multiple studies showing they in no way encouraged new drug use, but are effective to reduce the risk of blood-borne infections..’⁷ Why was it they were omitted? It certainly wasn’t based on scientific data, nor was it based on human compassion. ‘Interestingly this was also the year America marked the introduction of ‘The Helms Amendment’ which forbids federal funding unless the Secretary of Health and Human services can certify that these programs prevent HIV infection and that these do not encourage increased drug use’.⁸

What is even more disturbing, and I quote this with a terrifying sense of déjà vu, is that currently the ‘Russia Draft of the State Anti drug committee ....neither mentions HIV/AIDS nor the importance of preventing HIV...’⁹ If we look to Cambodia, there has been ‘a sharp increase of drug users sharing needles in Phnom Penh after one of only two NGO’s that was legally allowed to distribute clean needles in the capital lost its Needle and Syringe Program (NSP) license’.¹⁰The funereal amendments and glaringly inadequate declarations which these examples typify mark an almost pathological inability to see injecting drug users as part of the broader community. How anyone who has seen the effects of HIV, or has lived within a community decimated by the disease, could then go on and not only ignore lifesaving measures but legislate against them, beggars belief.

All too often when injecting drug users get together at conferences, both nationally and internationally, we try to deconstruct the negative and polarising effect we have on the wider community. We get the fact that no one likes to have their possessions stolen -we don’t either! We get the fact that personal and dental hygiene may be overlooked in the struggle to stay alive in a society that is at war with us; we get all that. But we also understand that much of the anti-social behaviour attendant with illicit drug use is clearly exacerbated by the legal status of the drugs. What we don’t get is that policy makers and governments are able to treat us with such absolute contempt and insidious, deliberate neglect. Unnamed judges, Salvation Army personnel and various other civic stalwarts have enunciated the belief that we would be better off dead than living with an addiction (well alcohol and tobacco are okay); these statement are never met with any public outcry, in fact they are often lauded. HIV, hepatitis C, hepatitis B and tuberculosis will not be eradicated from my community until people do something. All of the people who sit there and say nothing while others excoriate drug use and drug users, while they quietly sip their chardonnay and sneak their sleeping pills, and even those who dance ‘ecstatically’, are part of the problem. Until people are willing to recognise their own prejudices and preconceptions, this issue will not go away.

To know that stigma and discrimination is at the heart of my community’s decimation we need to look no further than our own indigenous community. I won’t relay the numbers of HCV positive IDU in Australia; you should all know those figures. But let’s look to the levels of infection among our first people, those already stigmatised and discriminated against for other reasons. ‘The ‘Building the Evidence Report’ highlights the increasing disproportionate effect of hepatitis C (and HIV) on indigenous people who inject drugs.’¹¹ Rates of hepatitis C infection are between 2 and 11 times higher among indigenous people who use drugs. On top of this, the 2008 Australian NSP study found that ‘the proportions of people who inject drugs who identify as Indigenous increased from 5 per cent in 1995 to 8 percent in 2003 and to 10 percent in 2005 and 2006’.¹² Figures from the 2008 NSP Study have the percentage of people who use drug who identify as indigenous at 11 per cent.¹³ These figures should give everyone working in the area a sense of urgency, things must change.

In trying to understand how to tackle the ongoing problems of stigma and discrimination in relation to bloodborne virus transmission, AIVL requested funding to undertake an Anti-Discrimination Project. Phase 1, the market research component, looking into the communities attitudes towards injecting drug users has just been completed. It will be very interesting to see the findings. Once the report has been studied AIVL will apply for further funding to initiate a national anti-discrimination campaign. We hope this will foreshadow a monumental shift in the wider community’s attitudes to and understanding of illicit drug users.

We could whine and blame others, but we don’t want to do that! We want to be given the tools to address the problems ourselves, but we will need some help.

References

1 Anti discrimination board of NSW (2001) C-Change: Report of the Inquiry into Hepatitis C Related Discrimination Attorney General Department, Sydney, NSW, Australia.

2 Senate Community Affairs References Committee (2004)Hepatitis C and the Blood Supply in Australia Commonwealth of Australia

3 Department of Health and Aging (2005) National Hepatitis C Strategy2005-2008 Australian Government Canberra, Australia p 23

4 Open Society Institute (2009) At what cost? HIV and the Human Rights Consequences Of The Global War on Drugs New York p 6

5 UNAIDS Joint Action for Results UNAIDS Outcome Framework 2009-2011

6 Open Society Institute, (2009), At what cost? HIV and the Human Rights Consequences Of The Global War on Drugs, New York p 6.

7 ibid

8 Harald Pollack, Contemporary Drug Problems Summer 2008;35,23 Health Module Moral, prudential and political arguments about harm reduction p 221

9 Talking drugshttp://www.talkingdrugs.org/russia-draft-drug-policy-says-no-to-harm-reduction16.2.10 9.22 am 

10 http://talkingdrugs.org./cambodian-needle-exchange-loses-its-license 16/02/2010/8:32 am

11 Grew, R et al (2009) Building the Evidence Report: Review of the evidence on interventions to reduce the incidence of hepatitis c infection, BBV & STI Sub-Committee PDHPC AHMAC Canberra p19`

12 National Centre in HIV Epidemiology and Clinical Research (2009) Annual NSP Survey; National data report 2004-2008Prevalence of HIV, HCV and injecting and sexual Behaviour Among IDUs at needle and Syringe Programs; The University of New South Wales, Sydney NSW p 9

13 National Centre in HIV Epidemiology and Clinical Research (2009) Annual NSP Survey; National data report 2004-2008Prevalence of HIV, HCV and injecting and sexual Behaviour Among IDUs at needle and Syringe Programs; The University of New South Wales, Sydney NSW p9

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Jude Byrne has been an injecting drug user for 37 years and worked in the BBV and injecting drug users advocacy and representation sector for over twenty years. She works in the AIVL Education Program and is Vice-president of the International Network of People who use Drugs (INPUD). 

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