Six years ago Hepatitis ACT moved from one part of Canberra to another. The old home, says executive director John Didlick, was very close to a secondary NSP, a primary NSP and also a secure dispensing unit (syringe vending machine).
“There was no need for us to offer an NSP as part of what we did,” he says. “It would have been an embarrassment of riches.”
They then moved to Canberra’s inner-north “to an area where there were drug users as well as people from elsewhere buying drugs. So geographically we went from no need for an NSP to an area where we could absolutely contribute primary prevention services.”
The NSP side of the operation was very quiet initially. No one came in. “The strategic approach to promoting NSPs in Australia has been to not promote them, to not draw the community’s attention to it.” But then after a couple of weeks a man came in to the centre with three needles he’d found in a nearby park, and he blamed the new NSP fairly and squarely.
“He said ‘this shit’s only started happening since you moved in,’” says John. But the NSP had not yet distributed one needle. It highlighted something to him.
“We needed to do absolutely everything we could to be a good neighbour. To find a balance between distributing as much sterile equipment as people need to prevent negative health outcomes and also to encourage people to return equipment and dispose of equipment appropriately for the public health benefit but also to protect us and the NSP network more broadly.”
Six years in, John’s set-up is, he says, working “brilliantly.” He is big on incentives and realises there are only mainly disincentives – or perceptions of them – to people disposing of used injecting equipment well. People can dispose of equipment incorrectly because they don’t want to be caught with it.
“Can I be charged with self-administration?” says John. “Or be suspected of using it as a weapon? Can they search my car and my flat? Will they think my kids are at risk?”
To ‘incentivise’ clients they hold a monthly raffle, the winner gets a $25 Woolworths voucher: “for smokes or dogfood or whatever they need,” says John. “Anyone who returns used equipment and disposes of it correctly in our bin, their NSP code name goes in the draw. It is extremely popular. You get in big trouble if you forget to put someone’s name down.”
As for public perception and public health risks, John is very clear. “The level of alarm does not match a public health threat. I have absolutely no evidence at all of even one instance of a needlestick injury in the community transmitting Hep B, Hep C or HIV to anyone.”
John says hysteria about public injuries and disease is fuelled by media reports about needles. He and his team pick them up from public places and dispose of them, and he says members of the public, after determining if the needle is safe to pick up, easily dispose of one or more safely. “It’s about as threatening to the community as a Coke can in the gutter, but I’ll pick them up because I don’t want to cause angst or concern for people.”
– Chris Johnston