Local community resistance was among the many teething problems when the first syringe vending machines were installed in NSW in the early 1990s. These days, the machines are generally accepted as just another aspect of effective NSP service range.
Gary Gahan remembers those first thorny years, when he was manager of a Sydney NSP. One of the machines – first trialled in 1992 in New South Wales – was at a community health centre but near a school. A parent found some fit packs left on the school grounds. The issue blew up on talk-back radio. The machine was decommissioned amid the outcry, but it didn’t prevent a rapid rollout elsewhere. Now there are hundreds around the country.
Gary, now Coordinator of NSW Health’s HIV/AIDS & Related Programs Unit, says that despite community concerns that may arise when a machine is installed – such as syringe disposal – the trepidation is usually unfounded.
“Our approach is to have a syringe management plan in place, so we liaise with local councils and other services to have rigorous procedures so that the impact on public amenity is really minimised,” he says.
Some NSP workers may be concerned that the machines can reduce face-to-face contact with clients, but in general they help serve people who can’t or don’t want to enter an NSP shopfront, for a range of reasons including time. Others, such as young people, “white collar” or “suits” types, may be too nervous about entering.
“To have an effective NSP requires you to have a range of modalities across a range of locations and settings,” Gary says. “The limitations of providing access to a 24-hour staffed service are obvious.”
While Gary knows of one suburban staffed NSP that is underutilised because the two nearby vending machines are going gangbusters, he says this scenario depends on the demographics of a given area.
It is more common that vending machine usage is high, while client contact at the associated staffed site has not reduced.
“The whole issue around stigma and discrimination and preserving client anonymity is huge in terms of vending machines,” he says. “They really meet that niche.”
It was only in 2014 that Monash Health in Melbourne introduced the first machines to Victoria. In the first year of operation, with one machine at each of the Clayton, Dandenong and Casey sites, only about 1000 syringes were dispensed per month. Now that figure has risen to more than 4500 a month.
Monash Health NSP Team Leader, Theresa Lewis Leevy, says the overall effectiveness of the machines is positive.
Statistics show the average user of the machines is female aged 30-40, compared with clients at staffed NSPs who tend to be 30- to 35-year-old males.
“The SDUs [Secure Dispensing Units] were designed to add another level to clients being able to access sterile injecting equipment. As a manager of the service, I would like to think it is the rapport we have with our clients that maintains the continuity of clients coming back,” she says.
“Staff’s ability to remember the clients and refer back to past conversations – you don’t get that from the machines.”
According to Mitch Segal, coordinator at the ACT’s Directions NSP the machines are generally seen as a stop-gap for after business hours, rather than a replacement for the staffed site.
“If anything, clients would prefer to use our service as it is in a discreet location, they have access to a range of equipment not offered by the machines, and can also access counselling, access to other services, meals, support, or just a friendly face and a chat,” she says.
“Our clients realise that the NSP is a safe space without judgment or discrimination.”
In Melbourne’s inner suburb of Richmond there is a long-standing and active drug-using community that is culturally very diverse. In places like this, dispensing machines tend to complement face-to-face work rather than substitute it.
Penny Francis, Alcohol and Other Drug Team Leader at North Richmond Community Health, says 156,777 fits were distributed through their machine in the first 16 weeks after it was installed last June.
While the number of syringes supplied to clients by the face-to-face NSP has declined, the average number of syringes dispensed overall during the past four months has increased by 22 per cent.