Young people who live in houses and flats in the suburbs, attend colleges or universities and/or are employed or unemployed, are often involved in casual and occasional use of illicit drugs although many do not come into contact with health and welfare agencies. Some inject these drugs, which are more likely to be psychostimulants, predominantly amphetamines, than heroin. Their risk of infection with HIV and other blood-borne viruses such as Hepatitis C through needle sharing has often gone unnoticed because they have not been viewed as part of the 'injecting drug user' community. On the contrary, the risk of HIV/AIDS to such young people has largely been seen as residing in their sexual behaviour.
The study reported in this thesis is an attempt to redress this lack by exploring the injecting drug use, sexual behaviour and psycho-social contexts within which HIV/AIDS risk behaviours are enacted, in a group of normal (i.e. non-delinquent, non-homeless) young people living in Perth, an isolated capital city on the western seaboard of Australia. Various models have been developed to explain health risk behaviour. Many, such as the Health Belief Model, focus on the individual, and one of the aims of the project was to examine the efficacy of such models to explain the HIV/AIDS risk behaviour of young IDUs. One hundred and five young Perth people who used injectable drugs, 75% of whom were current or recent injectors, were recruited to the study through advertising and snowballing. Each was interviewed individually for at least 90 minutes and paid $20 for participation.
Thirty five convicted drug dealers in prison and four members of the WA Drug Squad were also interviewed to provide descriptions of the illicit drug market. The study was largely qualitative, so permitting respondents to speak in their own words, and used models of risk-taking behaviour to discuss and interpret the results. It was found that most of the respondents in this study felt that they were at little or no risk of HIV infection. Many believed that behaviours such as unprotected sex (and, for some, needle sharing) were not very risky because the prevalence of HIV/AIDS in Perth, especially among young people, was low. Injecting was popular among young drug users, and seemed to have frequently been initiated very casually.
Some respondents' first use of amphetamine was by injection, and even very occasional users injected. Only half of the injectors had ever shared a needle, but more than half could imagine a situation in which they might share, particularly with a lover. Needle sharing, however, was said to occur only in those situations when the IDU was 'desperate' - that is, wanted to inject but did not have a clean needle to hand, and these occasions were said to be rare. Respondents shared injecting equipment other than needles more readily than they shared needles, and some did not understand the risk of contamination from these practices. There was a general dislike of condom use, and most respondents claimed that their careful choice of potential sexual partners obviated the need to use condoms consistently.
However, 'safety' between lovers and friends who wished to have unprotected sex and/or share needles, was more assumed than negotiated: that is, there had seldom been adequate communication between the couple as to whether the assumption of safety was warranted. In general it appeared that the use of sterile needles on most occasions had become the norm, except in the particular case of needle sharing between lovers. Many respondents, however, were prepared to accept the view that there were times when injectors just 'had to' share. Whereas sharing only occurred when there appeared to be no other choice, unprotected sex, on the other hand, was the norm, and condom use for many only occurred when there appeared to be no other choice.
Various models to explain risk-taking behaviour, including the view that young people who inject drugs and are sexually active are 'pathological', or that risk behaviours can be explained within rational decision-making models, were discussed. It was concluded, however, that neither of these approaches accommodated the complex and various factors that impinged on the behaviour of these young people. When an environmental prevention model was applied, it was found that these factors influenced individual behaviour at a multiplicity of levels, from the intrapersonal, through interpersonal interactions and cultural mores, to the social and legal environment. These factors were conceptualised as constraints that could prevent young people from enacting their wish to remain HIV/AIDS free.
The data suggested that these constraints operated through limited knowledge about HIV/AIDS and the prevention of infection, taken-for granted social beliefs and understandings, the demands of peer relationships, social disadvantage, gender roles, engagement in criminal behaviour, the nature of health and welfare services, the attitudes and practices of service providers, and the legal and structural provisions of the society in which respondents lived. The implications of these findings for appropriate health promotion and education for young people like those studied were considered, and it was concluded that because the range of factors impinging on young people were so diverse and varied with each situation in which risk behaviour might occur, standard health promotion programs could often do little more than raise awareness of issues.
Peer outreach workers, on the other hand, could work with individuals and groups of young people to identify constraints and develop strategies for overcoming them.
Recommendations for this population in Perth included working directly with young people to overcome deficiencies in knowledge, develop more realistic attitudes and beliefs about HIV/AIDS and raise awareness about issues relating to intoxication and unsafe behaviour; attending to issues relating to transitions between non-injecting and injecting, including the legal status of drugs; developing mainstream programs to overcome social and educational disadvantage which was found to be associated with the most risky behaviour; working with pharmacy staff to develop more 'user-friendly' injecting equipment sales programs; expanding needle exchange programs; working to reduce discontinuities between law enforcement and harm minimisation programs; improving HIV/AIDS education in schools and promoting condom use in as many ways as possible.
Overall, it must be acknowledged that there are large numbers of 'normal' young people in Australia (and, at least, the UK) who inject drugs, many of whom do not experience significant negative consequences from their drug use and are therefore not in contact with health and welfare services. They are at risk, through their injecting and sexual behaviour, of HIV/AIDS, other blood-borne viruses and STDs, and research and health advancement programs need to be initiated and/or expanded if they are to be protected.