Doing the possible: harm reduction, injecting drug use and blood borne viral infections in Australia

Most surveys show that, other than among men who inject drugs and have a history of homosexual contact, the prevalence of HIV infection among injecting drug users (IDUs) in Australia is about 2%. Rates of needle sharing have also declined greatly in the last decade, although the high prevalence and incidence of hepatitis C infection suggest that existing strategies have not yet brought this epidemic under control. Harm reduction has been the major Australian approach to the reduction of blood borne viral infections (BBVIs) in IDUs. Harm reduction strategies include needle distribution schemes, drug substitution therapies and education about safe administration practices. Importantly, with IDUs as with gay men, the infected and affected communities have been brought into partnership with health educators, researchers and policy makers.This paper will review Australia's approach to the prevention of BBVI in IDUs and the effectiveness of current strategies. I will argue that while HIV/AIDS among heterosexual IDUs appears to have been successfully prevented, international experiences of rapidly emerging epidemics demonstrate there is little room for complacency. Moreover, reducing the incidence of hepatitis C and hepatitis B among IDUs remains a major challenge

TALKING ABOUT TESTING: OPPORTUNITIES FOR PREVENTION IN BLOOD BORNE VIRUS TESTING AND VACCINATION WITH INJECTORS

Permanent Link: The attached document may provide the author's accepted version of a published work. See Citation for details of the published work

Characteristics of medication overdose presentations to the ED: how do they differ from illicit drug overdose and self-harm cases?

Background Medication overdose accounts for >80% of hospital presentations for self-harm. Previous research has identified typical characteristics of medication overdose cases; however, these cases have not been well differentiated from other similar presentations, namely (1) illicit drug overdose and (2) self-harm by means other than overdose. Method A 12-month audit of medication overdose cases (both intentional and unintentional) attending the emergency department (ED) of a major metropolitan public hospital in Melbourne, Australia was conducted. Comparison was made with patients attending for illicit drug overdose or for self-harm by means other than overdose.Results Medication overdose cases (n=453) showed a broadly comparable profile with those found in earlier studies (predominantly female gender, aged in their 30s and referred for psychosocial assessment). A similar though not identical profile was noted for self-harm cases (n=545). In contrast, patients attending for illicit drug overdose (n=409) could be characterised as male, in their 20s and not referred for psychosocial assessment. Illicit drug overdose cases were more likely than either the medication overdose or self-harm cases to be triaged in the most urgent category (19.3, 3.8 and 3.9% respectively), suggesting a high level of acuity in this group. However, the illicit drug overdose group on average spent less time in the ED than medication overdose patients, and were less likely to require hospital admission. Conclusion On both demographic and treatment variables, patients attending the ED following a medication overdose more closely resemble those attending for self-harm by means other than overdose than those attending for illicit drug overdose

Cops, drugs and the community: establishing consultative harm reduction structures in two Western Australian locations

In Australia a police project incorporating four parallel trials was established to test a new model of illicit drug law enforcement, which gives greater emphasis to harm reduction at the community level. The project was based on a community-policing model developed in the United Kingdom and involved establishing a community based consultation structure comprising an implementation oriented Drug Action Team (DAT) and support oriented Drug Reference Group (DRG). Two of the trials operated in Western Australia: one in Geraldton, a small regional city; and the other in Mirrabooka, a large, diverse, metropolitan region within Perth. The project officers were faced with a number of challenges and had to develop strategies to overcome these. One of the important issues was the effect of continual changes in membership of DATs, and consequent fluctuating levels of enthusiasm and commitment. The size and composition of the DATs also had an impact on how they operated. Other issues included the management of different agency agendas and recognition that the project would only operate for a limited time. How the project officers dealt with these issues in their development of the DAT/DRG model and how the two trial sites incorporated harm reduction into illicit drug policing are presented and discussed