THE INTERNATIONAL JOURNAL OF DRUG POLICY 1993 4 2

ORGANISATIONS OF INJECTING DRUG USERS IN AUSTRALIA

Alex Wodak looks at the development of user groups in Australia.

Before the discovery of AIDS, the concept of an organisation of injecting drug users in Australia would have been considered botlt4 unnecessary and impractical. As in most parts of the world, injecting drug users (IDUs) were considered, almost without exception, contemptible villains whose antisocial behaviour could only be altered by use of the full force of the law. Indeed, the perception of IDUs as incorrigible demons was one of the earliest casualties of the process of developing a network of IDU organisations.

The spectacular achievements of male homosexual lobby groups in Australia and other countries in the early years of the HIV epidemic provided a model for other groups at risk of infection. As in other countries, soon after the epidemic was detected AIDS was catapulted into prominence by gay activist groups including ACT UP and relentless pressure exerted on authorities to maintain a focus on the prevention and management of HIV

As it became evident in the mid- 1 980s that uncontrolled HIV epidemics were occurring among IDUs in several Western countries, interest in an organisation of IDUs in Australia was stimulated. Awareness of the existence of junkiebond in the Netherlands began to spread among a small contingent of health workers and IDUs who were concerned about HIV This information increased optimism about the possibility of creating a viable organisation of IDUs.

Attempts to begin an organisation of IDUs started in Sydney in the mid- 1980s. Within a few years, several states began to establish their own organisation and a federal umbrella organisation was established. These organisations were all funded by state and commonwealth governments using AIDS resources. Demands rapidly built up for these organisations. HIV-infected IDUs unable toobtain support or feeling alienated from groups of HIV-infected male homosexuals were anxious to at last receive non-judgemental attention. Newsletters, pamphlets, posters and videos all appeared in abundance. IDU organisation were increasingly invited to take their rightful place on state or national committees. Their views were sought about the range of potential strategies available for preventing the spread of HIV and also regarding the equally important series of questions regarding implementation of approved prevention strategies.

As these organisations were conceived in terms of AIDS, they were incorporated into the structure which was created for state and federal AIDS organisations. This has had the advantage of providing support for what are generally acknowledged tobe vulnerable entities. However, there has -also been an important disadvantage. The more powerful and politically astute organisations of gay men dominated the AIDS organisation, with the result that the organisations of IDUs felt financially disadvantaged. The fact that the origin of funding was AIDS resources also enabled authorities to restrict activities to matters relevant to HIV infection. Advocacy for an 1 DU lifestyle was regarded as exceeding the remit of the funding.

The Australian IDU organisations have increasingly made their presence felt and generally in positive ways. Within a few years, these organisations were con. sulted early in the design stages of state and commonwealth education campaigns or other activities. IDU organisations advised governments about methods of improving the practices of IDUs in disposing of used injection equipment soon after the establishment of needle and syringe exchanges. IDU organisations also campaigned energetically in the consideration process established for designing a non-reusable needle and syringe. Some of the state organisations soon encountered major difficulties, attempting to meet the needs of individual IDUs while still trying to maintain afocus on changing the environmentof IDUs so that life-enhancing choices became easier.

After less than a decade of organisations of IDUs in Australia, it is now difficult to imagine how government departments could ever operate effectively in severalareas (including especially HIV infection) tiithout the existence of these groups. Although the rapid establishment and growth of IDU organisations has not been without problems, and managerial efficiency may not always have met expectations, there can be little doubt that these organisations have proved to be far more successful than many would have considered possible only a few years ago. There can also be little doubt that Australia would not have been able to maintain its enviable control of HIV infections in this population into the second decade of AIDS in this country were it not for the existence of IDU organisations.

Inevitably, some of these organisations experienced difficulties coping with members and even executives who were intoxicated on the job. Requiring a vow of perpetual abstinence from executive members would have clearly been an inappropriate response. Yet potential or actual damage to IDU organisations from intoxicated executives or financial improriety could also threaten the future of what were still vulnerable organisations surviving in an increasingly conservative environment becoming increasingly blasd about the possibility of an uncontrolled HIV epidemic in this population. IDU organisations have found themselves ~ caught in a difficult bind. Cleansing the executive so that current users were excluded may satisfy authorities but alienate the intended target population. Alternatively, allowing executive members to become or remain inefficient or to be exposed to the temptation of misappropriation when this might be irresistible could also ensure that IDU organisations do not survive at a time when they fulfil a most needed public health role. No easy answers to these difficult questions have emerged from the Australian experience. Problems of similar kinds frequently abound in other cornmunity organisations. In most jurisdictions, authorities have sensibly allowed these organisations some time to settle down and acquire management skills which will minimise the risks outlined.

The future of IDU organisations faces a variety of challenges. If HIV infections remain low in this population, they will face increasing pressure to divert funding to other areas. If HIV spreads among IDUs in Australia as it now has in so manycountries, an ever increasing requirement to support disabled HIV-infected IDUs will replace the present focus on prevention.

Dr Alex Wodak, Alcohol and Drug Services, St Vincent's Hospital, Sydney, Australia