APPENDIX 1 - SPECIAL ISSUES

Young People and Drugs and Sex Education:

I was about 15 or 16 when I started drinking and smoking pot ...I could never see myself being pressurised into it. It was just there and I did it you know. No one ever forced me.

I was about 18 or 19....1 was scared at first but the rush I got off with was fantastic.

We used to drink heaps when we were young ... back in those days everyone was taking dope - whatever you could get your hands on, just pills, grass and acid.- was using heaps of chemical dope, you know Morph and Peta and Pelafrin...sort of 16 1 suppose.

I was still at school: my parents were away. Oh it was just a very normal situation really. Nothing seedy ... nothing unusual....

Alcohol and pot I've been doing since I was 13 and then I went to - I had acid when I was about 15 and I used a bit of that - and ... I was still in pain and he gave me some smack for the pain so I started using smack when 1 was 15.

Going back into my early twenties and teens, when I was with my large sort of peer group ... there was a lot of experimental stuff then with LSD - I tried - we used to trip, we tried speed ... it was more of a sort of spontaneous ... look what I've got - let's have some! It wasn't awfully planned and there was a lot of smoking dope but no one ever seemed to get hooked on any of them and most people did it for the fun of it.

You need something that's going to get the message across ... Education in schools - and they won't do it ... They'd knock it right on the head. They don't even have sex education at a couple of schools...

For most of our sample initiation into a drug taking career began in the teenage years, whilst still at school or soon after leaving. Our sample includes no one attending secondary school although a number are still undertaking formal education. The range of drugs being taken at an early age provides confirmation of the existence of cross cultural drug taking subcultures among young people, despite the disapproval of societal opinion leaders, churches, most parents, teachers and the drug treatment agencies themselves. We have discussed above the crucial role of those assisting the drug initiate into injection drug use. Here we must comment on the inadequacy of drug, and sex, education in schools. There is considerable evidence that unless it is geared into young people's existing 'knowledge', i.e., that many do take drugs and are sexually active, it will fail. The necessity for a large scale renewal of the thrust of drug and sex education cannot be stressed strongly enough, and ties in with our discussion above of the need to decriminalise injecting drug use. The messages with respect to both safe using and safe sex will fall on deaf ears if it is informed by prior assumptions that drug taking and sexual behaviour by young people should be avoided. We will comment further on this with respect to the cultural theme of harm minimisation as the desired thrust of educational campaigns. Here, too, it is necessary to reiterate the need for more extensive education and discussion about AIDS in schools and other educational agencies. Misconceptions still abound, reinforcing the view that it is risk groups rather than risk practices which are at issue.

Gender Divisions, Women:

I don't know if it's more stigmatising ... it is, in a way, women are expected to function more than men are, you know. A woman cannot lie around being lazy and stoned all the time as easy as a man can ...I think ...I think there is a financial burden that   goes back on the women ... Just responsibilities I think fall back on women more than men, you know ... I've got to go out and earn money to support us because he's not going to ... it's just expected that you will finance their habit.

I was very young, oh god... - it wasn't a pleasant relationship. He turned very christian and became a born again Christian and he decided that women were evil, sex was evil, drugs was evil. He is an ex junkie, ex gambler-and me, I was another crutch for him to lean on so he decided that women were easy because women were there ... at that young age you start thinking that you are not desirable ... so he vetoed sex in our relationship and going from normal sex drive to having nothing and yet I would go over there and he would go ...uh, uh, uh, like that, and we would have sex and he would have this big thing afterwards ... that was your fault, sort of thing-I had broken his resolve... it was a weird relationship sexually.

[I'd use] at home so that people wouldn't know I'd been using at home .... or using in pubs and toilets and things like that I've done. The sort of help that's available - I don't feel comfortable with the thought of going to an NA meeting particularly with older men involved and talking about myself, whereas I might feel comfortable if it was a women's group.

They were talking about the way women worked in those groups and they found it didn't work for women - not as well as it did for men anyway. And a lot of it had to do with the humiliation factor ... the way women are socialised anyway. There's that assumption that they spend a lot of their time being humiliated and a lot of their time being very uncertain about themselves and very down and it didn't help them any to stand up and say I'm a drug addict or I'm an alcoholic ...[instead] my name's whatever and I'm a competent woman ...a really interesting turnaround ... Instead of making them realise they were nothing because most of them had already realised that, ... had spent a lot of their lives being shy about talking in front of other men ... and men who are used to dominating the conversation...

There are important signs in our data of significant gender divisions. A comprehensive analysis has not yet been undertaken but we will comment on some aspects which seem particularly salient. We have already discussed the issue of sexual practice and the effects of masculinist ideologies both as regards the reluctance of men and some women to initiate and practice safe sex, the lack of knowledge regarding lesbian safe sex and the difficulties women manifest in negotiating condom use. Here we will concentrate on other matters, the understanding of which will be useful for policy makers.

The data provide a range of examples of a gendered division of labour with respect to the activities associated with scoring, injection rituals, tidying up. In mixed sex, drug using subcultures, for example, men frequently take on the role of scoring, even though that may be from a female dealer. Women are more likely to be injected by men, and tidy up afterwards. In drug-using, heterosexual partnerships too, some female respondents describe themselves as playing a role in emotional servicing of their partners, taking on the responsibility both of ensuring that money is available for drugs and helping the other cope with 'sickness' or depression. Those not involved in regular partnerships were somewhat less integrated into a network of subcultural affiliations and more likely to manifest dysfunctional using patterns, suffer from financial problems, fears about social disclosure and concerns about having a habit. Such users are more likely to be injecting alone and secretively.

This may have some relationship to the masculinist bias of the drug treatment industry. We know that the employment possibilities for women without educational qualifications are more restricted than for men. The data seems to point to a greater likelihood that women are supporting their drug using through, at least in part, petty dealing. Other research highlights the lower incomes of women, especially those of single parents many of whom are reliant on state subsidies and live below the poverty line. Our sample does not include sufficient numbers of women who are also parents, albeit single, and it is already under-represented in the number of working class participants. Nevertheless in the course of the fieldwork we motivated, more, it was alleged, by the free childcare than the desire for treatment.

Our respondents who had experience of treatment agencies, were dissatisfied clients, in the main. Factors mentioned included the male centredness of treatment regimes, the shortage of accessible detoxification clinics for women, and the absence of flexible, community based services. The latter seems especially important given the range of health needs frequently required by women: with respect to their own health, that of their children, over contraception, other sexuality issues, and general psychological well-being. It is also important given women's frequent dependence on public transport and housing difficulties.

More research needs to be done by women on women drug users especially with respect to groups very difficult to access: young women, working class women, single parents, and other women with children, and women from the ethnic communities.

Prisons and the Normalisation of Unsafe Using Practices:

If the worst comes to worst, you score some gear, you haven't got a fit, you just walk up to the nearest guy and say, listen, if you can get a syringe I'll give you a taste, no problem. Yeah - it's funny, the smack used to hit, the arms and syringes would appear out of mid air, you know. If you had a syringe in the nick, you were laughing because anyone that wanted to borrow had to give you some, you know...the fits were being shared hundreds of times.

It is shit mate, still the same trouble down in - I mean there's no trouble for a syringe, it gets used 70-80 times. It's so bad, it's like a nail hook, you know, you've got to get some one else to sort of fucking hold your arms and oh, it's gross ... they make their own, you know...they get the ones where the picks pull off, get the inner tube out of a biro ... wash all the ink out anyway ... and somehow they mix up the gear, they suck it into this biro tube ... they shove it in ...I cannot understand, the government sort of goes violent ... we've got to stop those drug addicts. They won't give them any syringes and they fucking make their own, you know. It's bullshit ...I hate to think how many people in gaols have got fucking AIDS especially like the long serving fucking kinds ... they're just handing out condoms now.

Given our knowledge of the availability of drugs in gaols, and the impossibility of fully controlling access thereto, it seems imperative to provide a needle exchange service in every gaol. This is even more important given that many gaol inmates are there for drug offences: dealing, stealing to finance a habit, or being in possession. The long sentences incurred by many drug offenders provide little incentive to refrain from continuing to take drugs. If the accounts above are in any way accurate gaols are not simply places where the conditions of enforced deprivation add to the dangers of normalising drug use, but also where the normalisation of unsafe using practice occurs. Our knowledge of prison subcultures would lead us to expect considerable evidence of deviance disavowal among some inmates and a lack of concern about societal stigma. The mere fact of being an inmate is already to be stigmatised, so why worry about a double stigmatisation?

The institutional time structuring and array of rules still provide opportunity for drug consumption but under conditions not faced by other users outside gaols. The preconditions for life - food, clothing, shelter - are provided for, as are structured opportunities for social interaction with others. There is therefore less incentive for the inmate with a desire for and access to drugs to institute the control regimes regarding drug use which we have observed outside the gaols. This could have the effect of deviancy amplification, leading to more norm breaking than might otherwise occur. At the same time the thrust to tighten up prison discipline and otherwise reorganise prison management regimes to secure more 'control', could create the conditions for more oppositional resistance, of which drug use would be one element.

Studies of Vietnam veterans reveal that apparently widespread addiction under harsh conditions does not necessarily persist when civilian life is re-entered. Likewise an avid user of drugs in gaols is not necessarily a life dependent after release. Nevertheless, it is important that prisoners, not just those incarcerated for drug related offences, have access to drug counselling and drug education regarding safe using practices. If this were facilitated, to be conducted by using prisoners themselves, acting as AIDS prevention workers, it would add to the credibility of such information among gaol inmates.

Likewise, the necessity for education about AIDS and the processes of HIV transmission. The treatment of HIV positive gaol inmates is only one of the urgent issues requiring changes in prison management policy. Others are the need for educational training programs for prison officers, at every level and for all inmates. A readily accessible supply of free condoms will be useless if not accompanied by a culturally sensitive educational strategy regarding both safe sex and safe using.

Dealers as AIDS Prevention Agents:

I prefer to get from J. because I know the people ... and that I'm not going to get ripped off. I've know them for years.

Dealers ...I suppose you could call it a network: I have to definitively know the person because I have too much to lose. There are different groups for different drugs.

Mostly through friends or friends who know people ... Hammer usually comes from one of my flat mates ... knows a number of people up the Cross ... comes home with it and we all sit round the kitchen bench and just take our portions.

There's a lot of people who specialise in substances ... different people for different things ... at this stage now it is all very stable ...I go to the same people, they are reliable, there's never any problems except people tend to get arrested and you have to move on.

[There's a] regular person just a phone call away ... no friendship there, I ring her, tell her what I want and she tells me where to meet her ... we never discuss it on the phone, it is all coded ...I   will say I want one, two, or three, she will say ..how long ...15-20 minutes ... we've usually got three places to meet and she will just say one, two or eight ...I don't like going to her house to score ... less chance of getting busted I think... I've been scoring stuff off this woman for 15 months and you can only score between 9 a.m. and 8 p.m.... She doesn't give credit.

Dealers ... the needles, they just come with it ... they're not really out of pocket with it ... they just go back in the box anyhow ... they're friends. I n terms of potential nodal points for the transmission of accurate information middle level dealers are the obvious candidates since they are both, of necessity, meticulous about rule following and about safety issues. Their businesses bring them into contact with a wide variety of clients such that if they could be encouraged to broaden their business ethics to include ensuring that their clients have clean needles, are aware of risk practices, etc., more community education would be taking place.

Unfortunately since dealers are created by the structures of illegality which surround drug use, we are sceptical that their business practices could be so diversified. Quick and quasi-anonymous transactions characterise the client/dealer relationship and although many claim to be friends with their dealers the nature of the friendship is often fraught with ambivalence.

Petty dealing, however, is a different matter. Since most users are also from time to time dealers because of the shared political economy of drug acquisition and consumption discussed above, it should be possible to target user/dealers with respect to, say, taking responsibility for the availability of clean needles and AIDS prevention work.

What seems less likely in the absence of greater efforts to decriminalise drug use is any large scale development of community organisations from below emerging to take responsibility for community education among users. The development of such organisations presupposes a willingness to 'come out' which, in the present climate which encourages others to dob in drug dealers or users, is extremely unlikely. Organisations such as NUAA need strengthening and adequate support for their work and their participants' advice sought regarding how other such organisations in different geographical locations could be facilitated. Outreach programs, whilst significant in targeting specific hard-to-reach groups such as sex workers, teenage drug takers in working class areas, homeless users, etc., are by definition more likely to reach those whose use brings them into public spaces like streets, pubs, and cafes, and less likely to reach those whose use occurs in the private sphere in private homes as in most of our sample. The research team on this project found it difficult to include users accessed via the Tribes Campaign, for example. This might indicate either that such campaigns did not involve many users, or, more likely, that users generally are very difficult to access--qua users.

The conclusion we come to is that the most effective campaign, is one which treats everyone, regardless of their using or sexual proclivities as in need of frank, non-sensational and accurate information about safe using

and safe sexual practices. If ALL were targeted as both potential users and potentially at risk via unsafe sexual practices, it would help both to divert attention from 'risky types' to risk practices themselves and normalise the knowledge necessary for people to exercise responsibility to themselves and to others. For this to be done successfully would require a range of culturally sensitive educational strategies recognising the multiplicity of identities which exist in a pluralist society. This much is clear from our sample. They think of themselves primarily as lovers, housewives, community workers, students, unemployed people -- who happen to use.

Health education messages coming from above of course run the risk of disempowering those 'below' who are the targeted recipients of such messages. It is no part of our conclusion to disenfranchise those organisations, groups and individuals 'from below' already striving to take responsibility for their own health and well being. The sample itself provides evidence that much behaviour change has been effected as a result of such efforts, probably more so than in the non-using population.