Aivl youth report 1 2011

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Young People: Sex, Drugs & BBVs — Do They Really Care?

X AIVL’s National Youth BBV, STI & Drug Use Scoping and Consultation Report

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4612 DESIGN DIRECTION

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Australian Injecting and Illicit Drug Users League (AIVL) July 2011

YOUNG PEOPLE: SEX, DRUGS & BBVs – DO THEY REALLY CARE?

AIVL’S National Youth BBV, STI & Drug Use Project Scoping and Consultation Report

Australian Injecting and Illicit Drug Users League (AIVL)

July 2011

The Australian Injecting and Illicit Drug Users League (AIVL) is the national peak organisation for state and territory peer based drug user organisations and represents issues of national significance for people who use or have used illicit drugs.

Its mission is ‘to promote and protect the health and human rights of people who use or have used illicit drugs’.

© Australian Injecting and Illicit Drug Users League (AIVL) 2011 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Australian Injecting and Illicit Drug Users League (AIVL). Requests and enquiries concerning reproduction and rights should be directed to the Australian Injecting and Illicit Drug Users League (AIVL), GPO Box 1552, Canberra ACT 2601.

ISBN: 978–0–9870936–4–6

Suggested citation Australian Injecting and Illicit Drug Users League (AIVL) 2011, Young People: Sex, Drugs & BBVs — Do they really care?

AIVL’s National Youth BBV, STI & Drug Use Scoping and Consultation Report, Canberra, Australia.

Any enquiries or comments about this publication should be directed to: Australian Injecting and Illicit Drug Users League (AIVL) GPO Box 1552 Canberra ACT 2601 Telephone: (02) 6279 1600 Facsimile: (02) 6279 1610 Email: info@aivl.org.au Website: www.aivl.org.au

Published by: Australian Injecting and Illicit Drug Users League (AIVL) Layout and printing: Design Direction

Contents

ACKNOWLEDGEMENT………………………………………………….............................................................................4 INTRODUCTION…………………………………………………........................................................................................6 EXISTING BACKGROUND EVIDENCE – THE PROJECT RATIONALE…………………………………………………......9 METHODOLOGY……………………………………………………….................................................................................12 Steering Committee Membership………………………………………………............................................................12 Defining the Target Group……………………………………………...........................................................................13 Literature Scoping Exercise……………………………………………........................................................................14 Consultation with Young People & Services…...........................................................................................15 FINDINGS FROM CONSULTATIONS WITH YOUNG PEOPLE………………....................................................17 Blood Borne Viruses……………………………………………....................................................................................17 Sexually Transmissible Infections…………………………………….......................................................................18 Illicit Drug Use…………………………………….....................................................................................................19 The Provision of Education and Information…………………………..................................................................19 FINDINGS FROM THE CONSULTATION WITH SERVICES…………..............................................................21 RECOMMENDATIONS……………………………..................................................................................................24 REFERENCES………………............................................................................................................................26

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Acknowledgement

The author of this report is the Australian Injecting and Illicit Drug Users League (AIVL).

This report was written by staff of the Australian Injecting and Illicit Drug Users League (AIVL) including: Sam Liebelt Juliet Schofield Fiona Poeder AIVL would like to thank the following Steering Committee Members for their invaluable input and support throughout this scoping phase.

Nadia Gavin — Harm Reduction Victoria Farshid Zaman — DanceWize (Harm Reduction Victoria) Alisha Ross — Youth Empowerment Against HIV/AIDS (YEAH) Kat Byron — Youth Empowerment Against HIV/AIDS (YEAH) Sue Brownbill —South Australian Voice for IV Education (SAVIVE), AIVL President Sione Crawford — NSW User and AIDS Association (NUAA) Jen Johnson — Australian Research Centre in Sex, Health and Society (ARCSHS) Christine Kerr — South Eastern Sydney & Illawarra Area Health Service (SESIAHS) Jarrah Robbins — ACT Youth Coalition AIVL would also like to thank all the young people who gave their valuable time, knowledge and expertise to this project, and all the youth workers and youth service providers who allowed us access to their reports and on the ground experiences. We would also like to thank all the AIVL staff and the State and Territory drug user organisations for contributing to the consultation process.

This project is funded by the Australian Government Department of Health and Ageing.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

This report contains the findings and recommendations from the first stage of a new Australian Injecting & Illicit Drug Users League (AIVL) project, the ‘National Youth BBV, STI & Drug Use Project’. The project aims to provide peer-based education about the prevention of blood borne viruses (BBVs) and sexually transmissible infections (STIs) and their relationship to drug use. It is specifically targeted at young people, those aged between 18-29 years. The first stage of the project involved a scoping and review of relevant literature, a consultation process with young people and service providers and the development of a set of recommendations, all of which are outlined in this report. The recommendations presented here will form the basis for the next phase of the project – the development and implementation of a national peer education project to raise awareness of the relationship between blood borne viruses (BBVs), sexually transmissible infections (STIs) and drug use among young people.

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Introduction

AIVL is the peak organisation representing state and territory drug user organisations and issues of national significance for people with a history of injecting/illicit drug use, including people who are current drug users and those in opioid pharmacotherapy, and other, drug treatment programs.

AIVL is a peer-based organisation which means it is run by and for people with a history of injecting and illicit drug use. As such, AIVL represents a unique perspective, one based on respect and the recognition that people with direct experience of the issues AIVL represents are both capable of, and have the right to speak on their own behalf. Further, they have the right and capacity to participate in and manage their own effective responses to those issues. This important principle underpins all of AIVL’s work.

The decision to undertake a BBV, STI and drug use project specifically targeting younger people has been guided by their prominence as a key priority population group in all of the latest National Strategies for BBVs & STIs. The Third National Hepatitis C Strategy 2010–2013, for example, recognises that people who inject drugs are the highest priority population at risk of hepatitis C infection, with both new and potential injecting drug users (IDU) being a high priority.1 Research has shown that approximately 50% of hepatitis C infections occur within the first 12 months of commencing injecting drug use.2 Given that the median age for commencing injecting drug use is said to be 17–18 years old,3 a project specifically targeting younger people is an essential component of the response to BBVs and STIs in Australia. On a positive note, there has been a decline in hepatitis C infections among young people who inject drugs in the 15–29 year age group which has largely been sustained since 2007.4 Maintaining a downward trend in hepatitis C infections among young people, therefore, is an important aim of the National Hepatitis C Strategy. To do so, however, requires that adequate access to harm reduction information and services, and particularly to hepatitis C peer education, be given an equally high priority. This is recognised in the Third National Hepatitis C Strategy 2010–2013, which states:

“Young people have greater dependence on others for administration of their first injection and obtaining injecting equipment. There is a high risk of contracting hepatitis C shortly after the onset of injecting. It is therefore essential that people new to injecting: have access to education about hepatitis C; understand the routes of transmission and the high risk of hepatitis C associated with injecting compared to other modes of drug administration; are supported to develop skills to prevent exposure to hepatitis C; and have access to sterile injecting equipment in order to reduce the risk of acquiring hepatitis C.”5

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

Young people are also identified as a priority population group for action within the other national strategies, including: the Second National Sexually Transmissible Infections Strategy 2010–2013; the Third National Aboriginal and Torres Strait Islander Blood Borne Viruses & Sexually Transmissible Infections Strategy 2010–2013; and, by implication, in both the National Hepatitis B Strategy 2010– 2013 and the Sixth National HIV Strategy 2010–2013. This highlights the importance of not artificially separating the risk of hepatitis C infection among young people who use illicit drugs from the risk of other BBVs and STIs. The National Hepatitis C Strategy further acknowledges the role of risk taking behaviour and how a lack of understanding about the routes of transmission are factors that can place young people at higher risk of a range of BBVs and STIs.6 In order to address the above priorities, as identified across all of the national strategies for BBVs & STIs, AIVL has commenced a new national peer education project focused on the prevention of BBVs & STIs among young people who use illicit drugs. Whilst the project places significant emphasis on BBV/STI prevention education amongst young people who are already injecting drugs, we also believe there is strong evidence to suggest that there is a very brief window in which to prevent hepatitis C infection among new injectors. This necessitates a focus on young ‘illicit’ drug users more broadly, and not just on those who are already engaged in injecting drug use.

There is clear evidence to show that people who inject drugs usually use illicit drugs via other routes of administration (such as smoking, snorting, swallowing, etc.) before they commence injecting.7 It has also been shown that the majority of people do not inject themselves the first time they inject, and that the first injection is usually not planned in advance.8 This highlights the importance of targeting young people who are already using illicit drugs, but are not yet injecting. Such a focus has the potential to be a highly effective hepatitis C and other BBV prevention strategy. The National Hepatitis C Strategy has also identified lack of access to injecting equipment and lack of knowledge about routes of transmission as the main risk factors for young people in relation to hepatitis C infection. AIVL’s National Youth BBV, STI and Drug Use Project therefore targets young illicit drug users with the aim of increasing their knowledge and awareness of hepatitis C and other BBV and STI transmission routes, including safer injecting practices and how to access injecting equipment should they commence injecting.

Educating young people about issues such as injecting drug use and BBVs can be contentious and sensitive, with young people often reluctant to engage on such issues directly. For this reason, AIVL will take a broader ‘health promotion’ approach, focusing on general health, BBVs, STIs and illicit drug use. By including broader issues such as sexual health and STIs, young people involved in the project can feel less vulnerable and less likely to be identified as an “illicit drug user” as a result of their participation in the project.

To ensure the project is fully owned and driven by young people, AIVL began with a scoping and consultation phase to map the issues, and to identify key contacts and potential peer educators.

The outcomes of this phase, as presented in this report, will be used to inform the next stage of the project, that of the education phase. In addition to determining the peer education model to be used for delivery of the training, the education phase will also involve training and supporting youth peer educators. These peer educators will then trial the delivery of the training to their peers — young people who use illicit drugs — through targeted education initiatives and the development of web-based information. The peer education model employed in the second (education) phase will be

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externally evaluated to ensure reach, applicability and sustainability. AIVL believes this is consistent with the National Hepatitis C Strategy 2010–2013, which states:

“Although injecting drug use is a relatively uncommon activity across all age groups, young people are more exposed to this practice. In surveys of young people attending music festivals, for example, approximately 25 per cent had been offered the opportunity to inject drugs, or had a friend or partner who had injected. While only a small proportion of these young people may go on to inject drugs, they are important targets for hepatitis C prevention messages.” 9 AIVL believes it is uniquely placed to deliver a project targeted at younger people who use illicit drugs. As the peak body representing issues of significance for illicit drug users and those on pharmacotherapy programs, and with our extensive track record in providing accurate and credible information via peer-based education methods, AIVL brings an unparalleled understanding to the complexities surrounding drug use, whether injecting or not. Further, we have a demonstrated ability to reach people ‘where they are’, not where we might want them to be. This includes being able to reach people who do not access mainstream health services, and those who may not relate to mainstream public health education campaigns. These are some of the key reasons why AIVL has embarked on this project. We believe that recognising young people as the future of the country necessitates, among other things, an acknowledgement of the importance of accurate, credible information in relation to drug use, BBVs and STIs. We have a responsibility to ensure that young people have access to this information. Doing so allows young people to make better, more informed decisions about drug use and promotes understanding of BBVs and STIs. Ultimately, this contributes to providing young people with better opportunities to live fulfilling and healthy lives.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

Existing Background Evidence — The Project Rationale

The existing research on young people, BBVs, STIs and drug use provides a broad background rationale for AIVL’s ‘National Youth BBV, STI & Drug Use Project’. The project targets young people aged 18– 29 who are currently engaged in illicit drug use, or may in future be exposed to injecting and other illicit drug use. The latest national strategies on BBVs and STIs show there is a clear need to increase awareness and knowledge among young people about these issues. AIVL’s project also aims to increase the level of safe practices and positive experiences for those young people who do currently engage in high-risk behaviours, and those who may do so in the future.

One of the reasons for targeting this particular age group is that in 2009 there were an estimated 291,000 people in Australia who had been exposed to the hepatitis C virus — with 165,000 having chronic hepatitis C infection and early liver disease, and an estimated 74,000 who had cleared the virus.10 The highest rates of infection occurred in the 20–29 age group, predominantly those with a history of injecting drug use.11 Another study conducted between 1999 and 2002 found that the incidence of hepatitis C amongst people injecting for less than one year was 98.2 per 100 person years.12 Of particular relevance to AIVL’s project is that the average age of initiation to injecting drug use is said to be 18 years13 and that initiation to injecting is largely reported as unplanned. Coupled with the findings from surveys conducted at ‘The Big Day Out’ Festivals, revealing that 26% of young people had been exposed to injecting drug use through friends or partners,14 this suggests that new and younger injectors are potentially at increased risk of BBVs (HIV, hepatitis C and hepatitis B infection).15 Young people tend to have little accurate knowledge about BBVs and their relation to high risk injecting practices.16 Further, individual injecting practices tend to develop early in a person’s injecting experience, often as a result of their initiation to injecting. When we consider that young people may be reluctant to access youth services, health services, or needle and syringe programs (NSP), where safer drug use and BBV information is available, the need for a dedicated project aimed at educating young people before they commence injecting becomes a major, pressing priority.

Because many young people will be exposed to illicit drugs through their social networks, they need to be informed about illicit drugs in general — not just high risk injecting practices. The majority of people who do progress to injecting have used illicit drugs prior to their first injection.17 The 2007 National Drug Strategy Household Survey states that 23% of 14–19 year olds had ever used an illicit drug, with 16.6% reporting use in the past 12 months. In the 20–29 age group 54% had ever used an illicit drug, with 27.7% reporting use in the past 12 months.18 The most commonly used illicit drugs among young people are cannabis, methamphetamine and ecstasy. However, in recent years, research has shown a shift in illicit drug use, with a decrease in

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ecstasy and cannabis use, but an increase in cocaine, LSD and illicit pharmaceutical drugs.19,20 In addition, new drugs have come onto the market, such as mephadrone, DMT and BZP. Little is known about the long term health effects of these drugs, however a recent study has suggested that people who use these drugs may engage in higher levels of high risk behaviour than regular users of ecstasy.21 In this regard, STIs are also of concern, with infection rates increasing dramatically in recent years.

For example, chlamydia has continued to increase, with 80% of all reported cases in 2009 occurring in the 15–29 age group. Broken down further, there were a total of 16,168 cases in those aged 15–19 and 34,322 cases in the 20–29 age group, with females greatly outnumbering males in both instances.

Gonorrhoea rates have remained relatively stable since 2005, with the 20–29 age group consistently recording the highest rates, with 3,509 infections recorded in 2009. This is more than double that of any other age group.22 The Australian Government response to these high levels of STIs among young people has included a national youth STI media campaign, which commenced in 2009.

Generally, knowledge about STIs and BBVs among young people remains low.23 Whilst young women are more likely to have greater knowledge about STIs than young men, they have a considerably higher proportion of infections than their male counterparts.24 It may be that this is related to levels of health service access, symptom manifestation and testing, however further research is needed to confirm such an assertion.

One area of particular concern is the perceptions sexually active young people have about their risk exposure to STIs and BBVs. According to the 2008 National Secondary Students and Sexual Health Survey, 39.9% of students surveyed had engaged in sexual intercourse, and of those, approximately twothirds (66%) reported having had unprotected sex (ie sex without a condom) at least once. Furthermore, 30% of sexually active students reported sexual intercourse with three or more partners in the previous 12 months. Of those who were sexually active, only 8% believed they were at risk of HIV/AIDS specifically, and only 12% believed they were at risk of an STI. Perceptions of risk also appeared to be influenced by familiarity with one’s partner, and longevity of the relationship, where the more familiar one was with one’s partner, the lower the perceived risk of contracting an STI. In addition, knowledge about risks associated with oral sex was also very low amongst this same age group.25 Perceptions of BBV risk is also concerning with many young people engaged in practices with the potential for BBV transmission to occur, yet very few young people perceive themselves to be at risk or have high levels of knowledge about BBV transmission. For example, in one study only 36% stated that you could not get HIV from mosquitoes and only one third were aware that hepatitis C could be transmitted by sharing razors and toothbrushes.26 Particularly concerning is one study conducted by AIVL involving psychostimulant users showing that only 28.6% stated they were “concerned a great deal” about hepatitis C transmission yet 68.7% had used a syringe that someone else had given them,27 a high risk practice for hepatitis C transmission.

When considered overall, these figures indicate a disturbingly low level of knowledge about STIs and BBVs, a claim that is supported by both the high rates of STI and BBV risk practices amongst young people and their perceived low levels of risk.28,29,30 Providing information and engaging young people in STI, BBV and drug use education often generates controversy, and divergent viewpoints exist as to the best way to proceed. Barriers to engagement can include: embarrassment, fear of exposure and ridicule, minimum age restrictions, stigma, related illegality and negative perceptions about existing youth/health services. These can all impact on how, or even whether, young people access health and other services targeting them. In addition, young

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injecting drug users may rarely access NSPs due to concerns about the negative consequences that might occur as a result of being ‘outed’ as an injecting drug user.31 Such barriers are often compounded for youth of culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander (ATSI) backgrounds, as well as youth living in rural and/or remote locations. In addition, non-marginalised young people may not wish to be identified with those they perceive as being the ‘typical’ clientele of youth and other targeted health services.32 In terms of addressing young people’s knowledge about STIs, BBVs and drug use, a number of social marketing initiatives have been undertaken. These have utilised SMS, email and Facebook. Although social marketing undoubtedly provides scope to reach large numbers of young people, providing them with access to reliable and credible information, there is little evidence, to date, that this is an effective method for changing behaviours.33 One SMS project, conducted in 2008, found an increase in STI knowledge and testing, but very little difference in actual practice, such as the use of condoms with new or casual partners, for example.34 With any campaign targeting young people, it is very important to recognise that perceptions of risk are fluid, and subject to constant change.35 They change over time and they change in relation to context, personal experience and life circumstances, all of which are also subject to change. Changes in behaviour are often spontaneous, occurring within familiar social surroundings. This highlights the importance of the role that both the social environment and peers can play. It must also be recognised and acknowledged that risk can be viewed as something that is positively valued, that for young people risk is not universally seen as negative.36,37 Further, and difficult though this may be, it is also important to recognise the role of pleasure as an underlying motive in young peoples’ behaviour, in both their drug use, and in their sexual behaviour, as forms of experimentation. This is something AIVL believes is often overlooked. It should also be acknowledged that young people also try to balance pleasure and risk, such that pleasure is maximised and risks minimised, especially in relation to drug use.38

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Methodology

The scoping and consultation phase of AIVL’s ‘National Youth BBV, STI and Drug Use Project’ incorporated various activities. The aim was to gather a broad range of information, experience and evidence to guide both the consultation process and the ongoing project. Project activities included: convening a steering committee of key stakeholders; conducting interviews and focus groups with young people; and holding meetings and in-depth interviews with a variety of youth service providers and project workers, most of whom run peer education projects. In addition, AIVL distributed a confidential questionnaire and conducted a literature scoping exercise to examine the extent of research on young people, BBVs, STIs and illicit drug use. Employing a range of different methods allowed AIVL to ensure the second phase of the project will be guided by the existing evidence and the extensive experience available in the area of young people and health.

Steering Committee Membership To engage a steering committee, AIVL first identified a list of potential key stakeholders from a range of areas. The aim was to find people who might best assist and guide the initial developmental stages of the project. Those so identified were: youth and other health services, youth peer organisations, research institutions with a history of conducting youth-orientated research, young people in the target age group and AIVL’s own member organisations.

The potential key stakeholders were initially invited to join the Project Steering Committee (PSC) via an email which was either directed to service managers or, where a contact was already established, directly to specific individuals. Once the appropriate people had been identified and nominated, initial communication about the project took place via an electronic mail list. One of the aims of this initial approach was to gather a large range of ideas and perspectives, which were then refined into a guide for the first teleconference meeting of the PSC. The PSC currently consists of 12 people from a wide variety of services and organisations including: Youth Empowerment Against HIV/AIDS (YEAH); DanceWize (a Program of Harm Reduction Victoria); Australian Research Centre in Sex, Health and Society (ARCSHS); Hepatitis Victoria; The ACT Youth Coalition; AIVL’s President; and relevant AIVL project staff. During later focus groups, an additional three young people were identified and agreed to join the PSC. The PSC has held teleconferences and face to face meetings, as well as maintaining ongoing dialogue and discussion via email. The PSC’s terms of reference (TOR) have been tabled, discussed and accepted.

Discussion has also been held regarding ideas for potential consultation methods, existing research

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

into young people, BBVs, STIs and drug use, and ways in which to progress the scoping and consultation phase of the project.

It is anticipated that members of the PSC will continue to be engaged for the duration of the project, continuing beyond this initial scoping and consultation phase. The next PSC meeting will discuss the external evaluation process, as well as the recommendations of this report and the implementation of pilot peer education projects.

Defining the Target Group A key task of the PSC has been to assist in defining the target group. There are many existing definitions about what constitutes a “young person”, ranging from 15–24 years of age as defined by the United Nations,39 to the much broader 12–34 years of age as used in some European countries.40 AIVL felt, however, that a narrower age range was more appropriate for the purpose and scope of this particular project. In particular, it was felt that the needs, aspirations and experiences of a person aged 12 would differ widely from those of an 18 or 34 year old, and so incorporating such a large age range would limit what the project might hope to achieve.

The PSC decided that the lower age limit should be 18 years. This decision was based on the following factors: •

The prevalence of illicit drug use at 14 years and older;41,42

•

The level of risky sexual activities and STI prevalence in young people aged 16 and older;43,44

•

18 years has been reported as the average age at first injection in Australia for the last 15 years (1995 – 2010);45

•

The considerable hurdles involved in providing BBV and illicit drug use education to people under 18 years of age, particularly in relation to school students; and

•

Potential legal ramifications associated with working with people under 18 years of age, particularly issues of consent when working with minors.

An upper age limit of 29 years was agreed, based on: •

The prevalence of BBVs and STIs among young people under 29 years of age;46

•

Lack of protective behaviours practised amongst young people in regards to STIs and BBVs in this age group;47 and

•

The relatively high prevalence of illicit drug use among people over 14 years of age, but in particular in the 20 – 29 age group.48

In addition to defining the age group, the PSC also explored the types of young people to target. It was agreed to focus on young people aged between 18–29, who are considered ‘non-marginalised, who have exposure to illicit drug use (or may do so in the future) and who are not regularly engaged with a health service, such as a youth service or youth drop in centre. This decision was based on the idea that a number of services are oriented towards young people from disadvantaged backgrounds (e.g. homeless youth) and that many of these services already have at least some focus on BBVs and STIs, as well as drug use. The PSC felt the AIVL project provided an opportunity to capture some new information and evidence from a group that is not often targeted in this regard, thus adding something new to our

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existing knowledge, and therefore help contribute to building the evidence base when it comes to young people, BBVs, STIs and drug use.

Literature Scoping Exercise A literature scoping exercise was undertaken with assistance from the PSC. Several parameters were set, and both research and general internet databases were accessed. AIVL undertook to identify predominantly Australian-based research that was less than ten years old, and with a demonstrable relevance to the project. The broad database search terms included: •

young people and drug use;

•

blood borne viruses;

•

sexually transmissible infections;

•

sexual practices;

•

the influence of media on young people’s attitudes;

•

youth-focused media; and

•

peer education amongst young people.

Database searches produced a large amount of material. However, one particular limitation was that much of the relevant literature has focused on marginalised young people, such as young people who inject drugs, young people who are homeless or street visible and gay and lesbian young people.

A number of key research reports on general youth knowledge and behaviours were examined, including: the ‘National Drug Strategy Household Survey’, a random population based telephone survey on drug use and attitudes to drugs; the ‘Australian Secondary Students’ Use of Over-the-Counter and Illicit Substances (ASSS)’, a survey conducted with selected secondary schools; and the ‘National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health’, again, a survey conducted through selected secondary schools.

All three of these surveys are problematic, however, and this has been documented elsewhere. For example, the setting in which they are conducted (on the family telephone for example, or within a school setting) must at least raise some question as to the validity of the data collected. It is not unreasonable to expect that respondents’ answers may be influenced by those settings, with adolescents perhaps fearful of being overheard and/or identified, and therefore being concerned with issues of confidentiality.49 Concerns about divulging information about activities that are illicit and otherwise risky, such as drug taking and sexual behaviour can potentially lead to under-reporting and may not provide information as to the true prevalence of either sexual activity or drug use. AIVL does, therefore, urge caution when interpreting these particular findings, particularly if done in the absence of other supporting research data.

Another survey, however, conducted annually by the National Centre in HIV Social Research (NSCHR) at the NSW ‘Big Day Out’ music festival from 2006 to 2009, proved especially important in providing the broad evidence base for the AIVL project. Aimed at investigating drug use, hepatitis C and exposure to injecting drug use amongst young people attending the music festival, the NCHSR sample did not emphasise marginalised young people and so has been a good fit in terms of congruence with AIVL’s

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target group. Further, the Big Day Out data also supports AIVL’s decision to include in its target group, people with both exposure/potential exposure to injecting drug use (26% in the Big Day Out Survey) and poor knowledge about BBVs in general.

For example, out of this group of young people, only 69.5% knew hepatitis C could be transmitted by sharing needles and 66.1% knew it could be transmitted by tattooing and body piercing. Of further concern, however is that 46.3% did not know hepatitis C was not transmissible by sharing toilets or showers; and 41.1% did not know that sharing food, drinks and utensils was not a transmission risk.50 These results were almost identical to those from the ‘National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health Survey’. Even more alarming perhaps is the lack of knowledge amongst young people about where to access sterile needles and syringes, with only 11.9% correctly identifying where to obtain them.51 As identified in the Big Day Out surveys, a considerable number (26%) of people know others who inject, yet their knowledge about BBVs and how to access sterile equipment is limited, if not poor. Targeting appropriate education about safer injecting practices, BBV transmission and prevention through even a proportion of this group could have far-reaching positive effects for themselves and their peer group.

In relation to the issue of prevention of BBVs, AIVL acknowledges there is a significant focus in the literature on preventing the transition to injecting among young people.52,53 While recognising the role of prevention measures, it is also important to give equal emphasis to the prevention of BBV transmission through education that targets those who do go on to inject. This means promoting harm reduction through safer injecting practices, in addition to warning of the risks that unsafe injecting practices can present. For this reason, AIVL’s focus is to provide education primarily aimed at educating young people about how to engage in safe practices including where to access harm reduction services, and thereby minimise the risk of BBV and STI transmission.

Consultation with Young People & Services During the scoping and consultation phase of the project, AIVL conducted several focus groups and interviews with service providers and young people from a variety of backgrounds and settings. The aim was to ascertain current levels of knowledge and determine needs in relation to information provision about BBVs, STIs and drug use. Complementing the research literature, cited above, AIVL undertook a number of focus groups and interviews. This allowed us to investigate some specific questions of importance to the project, such as: •

What types of education appeals to particular groups?;

•

What are people’s perceptions of current (and past) government campaigns?; and

•

What relevance does BBV, STI and drug use education have in people’s lives?

It was felt that gathering this type of qualitative data would be of benefit to the overall success of the project.

The focus groups and interviews were instructive. Many of the young people provided the kind of insights and opinions not captured in the literature scoping exercise, but which we believed would be important in terms of how the education phase of the project should be conducted. For example, many young

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people consulted by AIVL felt that government campaigns on drug use and safe sex didn’t match their own experiences, and were therefore not seen as credible. However, and in almost direct contrast to this, most of these young people felt that when searching for specific information on the internet, they would often explicitly seek out government (gov.au) websites and websites that had government endorsement. They perceived these websites as credible and were preferred sources of information. It was felt these sites indicated that the information was “certified” by professionals and was therefore correct and reliable. This apparent contradiction suggests to AIVL that the Government and similarly endorsed campaigns should pay more attention to how they target their imagery when aiming to educate young people on BBVs, STIs and drug use.

AIVL also approached a number of services with a focus on young people, peer education, sexual health and BBVs to participate in an interview. Service providers and project workers were questioned in regard to the work they currently do, the limitations they experience, what they believe works in targeting young people, and what strategies they think AIVL could use to achieve its goals of raising awareness and increasing the knowledge levels of young people in regard to BBVs, STIs and drug use.

This was also instructive, but at times also concerning. Some youth service providers, for example, felt the type of general safer drug use and BBV prevention education AIVL was proposing would be construed as promoting drug use to young people, unless situated within an abstinence-based framework. Some of these service providers appeared to believe that placing young people in the same forum as current active drug users would impel young people to use drugs. Interestingly those services who are actively working with young people on BBV education and drug use harm reduction held views that were in stark contrast to the above services. These services felt there was an urgent need to address these issues very directly with all young people, particularly in light of the findings from research such as the Big Day Out study.

Another interesting viewpoint emerged from a question about where focused and targeted education was most needed. The issue of presenting more realistic and non-alarmist education in schools was raised on many occasions. From the focus groups and interviews, however, it appears that those services who have attempted to provide sexual health, BBV and drug use education to school aged young people (up to 18 years of age) have encountered insurmountable barriers. Participants stated that attempts to engage schools in accurate and realistic education programs on these topics, in any way that is not firmly focused on abstinence or a “Just Say No” approach, have been singularly unsuccessful. It was generally agreed that a great deal more work needs to be done to overcome this particular barrier.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

Findings from Consultations with Young People

As outlined above, AIVL conducted a number of focus groups and interviews with a number of young people from a variety of backgrounds and with different baseline knowledge levels about the issues.

While many of the young people we spoke to had somewhat similar experiences and thoughts about STIs, BBVs and drug use, their responses, as presented here, were surprising given the near saturation media coverage young people, sex and drugs attract. Whilst there was considerable overlap in the way the topics were discussed, the findings are presented here in discrete sections.

Blood Borne Viruses AIVL was surprised at both the poor levels of knowledge young people have, and the lack of importance they place on BBVs. Although there is a considerable amount of research undertaken and information available about BBVs, particularly hepatitis C, much of it is focused on those already engaged in high risk behaviours — such as injecting drug use. Little research examines the levels of knowledge among young people who are not injecting drug users.

During the consultations with young people AIVL discovered that while many young people are aware, to some degree, of what a ‘blood borne virus’ is, many could not name any BBVs other than HIV/AIDS. Those who could identify hepatitis C as a BBV, had very limited knowledge of what it actually is, how it’s transmitted, or how to protect themselves from transmission.

These findings are similar to market research conducted by NSW Health which showed that of 453 young people aged 16–24 years of age surveyed, half having been exposed to injecting, and half who had not, only 17% could identify “hepatitis C as a virus that affects the liver” and 7% stated it was “something that you caught by sharing injecting equipment or tattooing equipment”. Of greatest concern is the one third (33%) of those surveyed who stated they “did not know what hepatitis C was”.54 The extremely low level of knowledge among young people, along with surveillance data showing young people aged between 15–29 years accounted for approximately 2,700 new hepatitis C infections (1 in 5) in Australia in 2009,55 suggests there is an urgent need to address this knowledge gap in young Australians if we are to continue reducing the high rates of hepatitis C in this population group.

The focus groups also uncovered an extremely high level of confusion amongst young people in regards to BBVs and vaccinations. Many of the participants agreed with the statement “you can be vaccinated against hepatitis C”. AIVL believes this is probably due to the inclusion of hepatitis B vaccination in Australia’s immunisation program, whereby school-aged young people have been vaccinated against

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hepatitis B, but have not been provided with adequate education about the hepatitis B virus, nor with education about other BBVs, about how they are and are not transmitted and prevented.

When the topic of injecting drug use was discussed, a surprisingly high number of people said they had been exposed to injecting, with 50% stating they had a friend or partner who had injected. This was higher in the AIVL focus groups than the ‘Big Day Out’ Study’s 26% of reported exposure to injecting through friends, partners or acquaintances.56 Furthermore, only a few focus group participants stated they had themselves ever injected illicit drugs, although a majority had used illicit drugs and did so on a fairly regular basis (more than once a month).

Given the evidence about how and when first injections occur, and the high rates of hepatitis C infections that occur soon after injecting commences,57 AIVL believes the focus of its Youth BBV, STI and Drug Use Project is of paramount importance.

Sexually Transmissible Infections As with the discussions about BBVs, the discussion about STIs uncovered some worrying beliefs. Many of the sexually active young people stated they were either not at risk, or only somewhat at risk from contracting STIs. This was the case with both heterosexual young people and those who engaged in same sex sexual activity, with many young lesbian women believing they were not at risk of contracting STIs because they didn’t engage in “traditional” heterosexual vaginal intercourse.

The focus groups also revealed the level of knowledge of STIs among young people who were currently involved in youth and other health services to be similarly limited, and of no comparable difference to those young people who were not involved with such services. This highlights the lack of engagement by youth and health services on these issues, and reaffirms the fact that many young people simply do not consider themselves to be at risk of STIs. This is particularly concerning considering the current levels of STIs amongst young people, including: •

50,490 young people aged 15–29 were diagnosed with chlamydia in 2009 (a considerable increase from the 32,589 diagnosed in 2005); and

•

4,046 young people aged 15–29 were diagnosed with gonorrhoea in 2009 (which has been relatively stable since 2005).58

Coupled with the beliefs expressed in the focus groups, these figures are alarming indeed. Clearly, if we are to reduce these rates of infection, we must devise better strategies and campaigns to raise awareness of the risks and educate people about how to protect themselves and others.

The high STI rates led us to explore the perceptions of young people regarding the relevance of previous STI information/education campaigns. Surprisingly, given the low level of awareness of STI risks within the focus groups, most young people could readily recall that there had been government-run STI campaigns in the past. However, they also said that such campaigns very rarely caused a change in risk taking behaviour. As noted earlier, AIVL believes this is partially due to a gap between the reality of their own experiences and those portrayed in such campaigns. Further, because these campaigns typically depict traditional heterosexual imagery, young gay and lesbian people feel particularly removed from such campaigns.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

On the other hand, and as already mentioned, while failing to result in significant behavioural change, young people nevertheless regarded government websites and printed materials as credible and their preferred source of information, not only about STIs but for most health-related topics. In this context, young people appear to make a subtle but important distinction between ‘relevance’ (that is whether the information and imagery is ‘relevant’ to them) and ‘credibility’ (that is whether the source of the information is considered ‘credible’) and the factors that lead them to trust particular sources of information.

Illicit Drug Use In relation to illicit drug use, the majority of young people in the focus groups had experience with illicit drug use, particularly cannabis and ecstasy. There was a relatively high level of methamphetamine use, but less so of heroin use, and few stated they had ever had any dependence on illicit drugs. These reported rates of drug use are consistent with those found in the National Drug Strategy Household Survey 2007 59 amongst 20–29 year olds, which showed: •

49.5 % had ever used cannabis;

•

23.9 % had ever used ecstasy; and

•

16% had ever used methamphetamine.

Most of AIVL’s focus group participants said they engaged in “recreational” use of illicit drugs, and they did so for fun and enjoyment, to increase confidence in social situations and also out of curiosity. Many also stated they felt that drug use was “not a major problem” and that it was “just what young people do”. Because of these attitudes, and to ensure a credible campaign, AIVL believes it is important to include safer drug use education in all BBV and STI prevention education targeting young people.

The issue of sharing information and education about safer drug use with friends (i.e. peer education on safer drug use) was also discussed. Many said that if they received and retained accurate knowledge on safer drug use, they would be willing to share this knowledge if they were present when their friends and peers engaged in drug taking. These young people also expressed a great degree of tolerance towards friends who engaged in illicit drug use. Rather than abandoning their drug using friends or leaving them alone many wanted information on ways to support and care for friends under the influence of drugs, as well as information on what to do if their friends had a bad experience.

AIVL believes this level of caring and the willingness to support their friends’ choices presents opportunities to develop a meaningful youth peer education model, one that can have real impact in terms of raising awareness and increasing safer practices amongst young people. It also reinforces AIVL’s decision to focus its project on a broad range of young people, people who may be exposed to illicit drug use more generally, rather than exclusively targeting injecting drug users.

The Provision of Education and Information In the focus groups, young people said that information and education about safer drug use was more meaningful when provided by their friends. In other words, peer education was preferred to most other sources, including youth services or doctors. Participants felt that if they (or their peers) had accurate information, then a peer education model would be better as it would not be judgemental or unrealistic.

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Although this may appear at first glance to be contradictory to the above preference for accessing information on STIs through “government approved” sources, it does in fact simply reinforce the need to provide a range of access points and types of information for young people to meet their needs in a variety of circumstances.

When asked about accessing information on BBVs, STIs and drug use from family members and schools, many said that seeking this information from these people, especially parents, school counsellors and health teachers, is often “embarrassing”. In addition, it involved matters that are often “sensitive” and matters that are regarded as “bad and unacceptable” behaviour. They are also reluctant to approach these authority figures for fear of being disciplined or ‘outed’ to family and/or school authorities as someone who engages in risky and/or illicit activities.

The idea of providing information and education at youth-orientated events such as music festivals through designated ”chill-out” areas and information desks was also discussed. This is not usually considered a conventional method of education provision, but many young people felt that, because illicit drug use often occurs at these events, it would be highly effective in reaching those who might not otherwise access the information. They also felt that if it was provided in a chill-out space, where many people go to ‘wind down’ and recuperate, it would be an appropriate method of providing such education. They felt that this would be well received, on condition that it is provided by “credible” young people and peers, or by an appropriate organisation.

Further, this type of education should always be provided on the basis of an ‘opt in’ approach. Opting in ensures it is provided when appropriate, and ensures young people are not bombarded with information that they may not want to receive, at that particular time and place. An example of this type of model is the ‘DanceWize’ program in Victoria, where peer educators attend dance music events and festivals.

‘DanceWize’ has been very successful; operating for almost 20 years.

The internet was also discussed as a primary (and often preferred) source of information about BBVs, STIs and drug use. The ubiquity of the internet, and young people’s familiarity and access to it, makes it a valuable educational tool when it comes to BBV, STI and drug use information. Many feel the anonymity of the internet helps to allay fears of discovery or disclosure, and that this is a confidential way to access information. All of the focus group participants were aware of ways to ensure they are not “found out”, by deleting browsing history and web search results for example. Use of the internet, then, is a way to provide information and education in ways that young people are comfortable utilising.

The young people AIVL consulted were amazingly open and honest when discussing such sensitive issues as BBVs, STIs and illicit drug use, and often showed a level of insight beyond their age. They were enormously helpful, informing AIVL about appropriate ways to engage with young Australians, such that we develop a credible, informative and inclusive education campaign that will resonate with young people. We hope that in the process we increase their knowledge and awareness of the issues, and helping to reduce risk taking behaviour that many may see as just a normal rite of passage into adulthood.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

Findings from the Consultation with Services

Throughout the scoping and consultation stage of the National Youth BBV, STI & Drug Use Project, AIVL contacted workers involved in BBV and/or STI projects with an emphasis on youth focused projects. The majority of the projects AIVL consulted with have been established for many years, and as such provided valuable insights.

The types of projects involved were divided into three categories: •

Peer education projects: as a method of disseminating information to a targeted population who have similar beliefs, attitudes, ages, social status and most importantly experiences. Training and education is provided to individuals of this group, to ‘peers’, who then share their knowledge with others during formal or informal interactions;

•

Awareness campaigns: a popular method of raising the level of knowledge of a particular topic amongst a group, or community; and

•

Product driven projects: usually involving highly structured brief education and information sessions. Participants then use the knowledge they have gained to create or help develop an end product such as artwork or resources.

As reflected in research, and from our own experience, peer education was considered the most effective way to engage young people in STI and BBV education.60 Repeated informal and opportunistic information sharing by peers is an important way to spread harm reduction messages to large numbers of other people within their own social networks. Additionally, it is highly cost effective. Networking and building good partnerships with local organisations enhances the reach and effectiveness of these projects. Young people relay to their peers the information they believe is reliable, credible and relevant.

Project workers acknowledged that individual experience and knowledge that each peer holds is used to strengthen the reach of their projects.

Key to the success of peer education are: •

Provision of accurate and up-to-date information;

•

Advice on how to negotiate difficult situations;

•

Regular debriefings;

•

A clear understanding of the peer’s role and boundaries;

•

Access to services for personal support;

•

Further training; and

•

Involvement in the implementation and development of the project.

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In non-metropolitan areas, regular contact with the organisation responsible and a feeling of involvement were seen as essential to prevent feelings of isolation and attrition. These projects developed over time, refining their methods and adapting to local issues.

The issue of sustainability was mentioned by all the peer education project workers. Funding, or rather the lack of funding, was a subject for concern. Many project workers find the funding they receive to be insufficient, resulting in them devoting their own unfunded time and resources to their projects in order to sustain them. Funding issues also affect the improvement and expansion of projects. Recruiting new participants and retaining current peer educators was an issue for projects operating in rural areas too, as over time the small pool of potential participants is exhausted.

Evaluation of peer projects was also raised by all the project workers consulted. Outcomes can be difficult to measure, and projects must have clear goals, aims, and outcomes. The structure of a project must be developed with evaluation in mind, and this can make it difficult to meet the objectives of peer education. Continuation and funding of projects can often hinge on the results of measurable outcomes in evaluations. Many projects are also altered over time to incorporate methods to allow for clear evaluation.

Product driven projects are an effective method of improving knowledge levels and engaging young people, especially for those who are hard to access or marginalised. Workers said that the benefits of these projects for young people include: contact with service providers; working towards a clear goal; their contribution is valued; a sense of accomplishment; and the opportunity to be proud of achievements that they can share with their family and social network.

Unfortunately these types of projects involve brief interactions and do not provide the opportunity for knowledge to be reinforced and updated over time. Long term product driven projects that occur annually can often become neglected as service providers focus on their core activities. Continual promotion and networking with services that host these projects is needed to prevent this from happening.

Awareness campaigns can reach large numbers of young people but need to be supported by a widespread, coordinated approach. These projects involve a large amount of scoping, market research and focus testing in an attempt to ensure that resources and promotional materials are suitable.

Unfortunately, with one BBV awareness campaign, AIVL found that some young people felt alienated by the messages and it raised the potential for increased stigma and discrimination. This same concern was expressed by other services and organisations as well.

In the course of the consultation, it emerged that project workers could make much better use of the media. Many of those consulted did not engage the media at all, or very rarely. In relation to STIs, BBVs and illicit drugs the media can be used as a tool to promote projects, convey information, correct misperceptions, change attitudes and encourage harm reduction behaviours.61 An area of concern in the consultation with services was the reluctance for some mainstream services to be willing to adopt illicit drug use education measures. This was the case despite the fact that some of these organisations have an exclusive focus on BBVs. Given that 90% of all new hepatitis C infections are due to injecting drug use,62 AIVL believes such education is vital. Workers from these organisations, however, believed AIVL and its member organisations, which employ people with a history of injecting and illicit drug use, were best placed to undertake illicit drug education for young people. Some of

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

the workers from these organisations raised issues surrounding the perceptions of encouraging drug use and that of ‘contamination’. Illicit drug education, especially when it involves injecting drug use, continues to be a contentious subject.

All workers mentioned the lack of secondary school based STI, BBV and illicit drug education as an issue. As the majority of young people now remain in school beyond Year 10, it is an ideal opportunity to present and reinforce relevant, accurate and consistent information. Workers stated that drug user organisations and peers with a history of drug use were highly suitable to deliver illicit drug education in schools. At the current time, however, and in the foreseeable future it is unlikely that this is a realistic option. School and Education Department approval, the need for parental consent, access to students, and backlash from Parents and Citizens groups, as well as general community attitudes were cited as just some of the many barriers to such a proposal.

Overall, the projects which were generous enough to give their time to this consultation and scoping phase provided many valuable insights about their experiences in delivering a wide range of youth focused projects and services. They were happy to provide AIVL with details of what works, and what doesn’t and all expressed their support for AIVL’s National Youth, BBV, STI and Drug Use Project.

AIVL’S National Youth BBV, STI & Drug Use Project – Scoping and Consultation Report

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Recommendations

While STIs are often seen as separate issues to BBVs and illicit drug use, AIVL believes it will be beneficial to incorporate all three into the one project. This extends the reach, and impact, such a project might have because it will be targeted as a comprehensive package of health and lifestyle education, one which includes disease prevention. People who might not otherwise be receptive to BBV prevention education will nevertheless have access to it. This approach is consistent with the National Hepatitis C Strategy 2010–2013 in which the importance of not artificially separating the risk of hepatitis C infection among young people who use illicit drugs from the risk of other BBV and STI infections has been clearly articulated.63 The following recommendations have been incorporated into AIVL’s proposal for the next phase of the National Youth BBV, STI & Drug Use Project, to commence in 2011–2012.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

Recommendation

Objective

Activity

Responsibility

Peer Education

Develop and pilot a model of peer education with young people on BBVs, STIs and illicit drugs

Work in partnership with youth-based agencies (e.g. Youth Empowerment Against HIV/AIDS – YEAH) to develop the peer education model

AIVL and established youth based agencies

Provide enhanced BBV, STI and safer drug use information and support at music festivals, clubs and other relevant events

Conduct and evaluate two peerbased ‘chill out’ information zones at specified events

AIVL, ‘DanceWize’ peer educators and Harm Reduction Victoria

Raise awareness of STIs, BBVs and safer drug use

Provide peer education training and awareness raising information for ‘DanceWize’ peer educators on BBVs, STIs, illicit drugs and harm reduction approaches

AIVL and Harm Reduction Victoria

Increase knowledge about the importance of holistic youth based health services in relation to BBVs, STIs and safer drug use

Attend and present at relevant conferences

AIVL and AIVL member organisations, youth health service providers

Raise awareness of AIVL’s Youth BBV & STI Prevention Campaign

Disseminate the findings and recommendations of AIVL’s “Young People: Sex, Drugs, & BBVs – Do They Really Care?” Report — via web-based forums, youth events and other relevant forums

AIVL and AIVL member organisations

Increase young people’s knowledge about BBVs, STIs and safer drug use

Identify and engage relevant youth orientated media (such as street press) to promote awareness of BBV, STI and drug use issues and to publicise the education phase of the project

AIVL and AIVL member organisations

Online and Social Media

Provide up-to-date and relevant information for young people, particularly as it relates to psychostimulanttype drug use, BBV prevention and health.

Develop new content, and update existing online content to incorporate BBV, STI and safer drug use education that targets young people on the AIVL website. This will include updating the current AIVL “Wizz Wize” site which contains information on BBV prevention and methamphetamine use

AIVL, AIVL member organisations and other relevant youth based health agencies

School-based education

The adoption of relevant and realistic BBV, STI and drug use education in secondary and tertiary educational institutions

Investigate how current BBV, STI and drug use education initiatives are conducted in order to encourage and promote early intervention initiatives which young people will find relevant and engaging

AIVL, AIVL member organisations, and appropriately identified partners

Awareness Raising

Identify appropriate partnerships to promote the goal of having relevant and realistic BBV, STI and drug use education adopted

AIVL’S National Youth BBV, STI & Drug Use Project – Scoping and Consultation Report

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References

1

Australian Government Department of Health and Ageing (2010) Third National Hepatitis C Strategy 2010– 2013, Commonwealth of Australia: Canberra.

2

Maher, L., Li, J., Jalaludin, B., Chant, K.G. & Kaldor, J.M. (2007) ‘High hepatitis C incidence in new injecting drug users: A policy failure?’ Australian and New Zealand Journal of Public Health 2007, 31(1), p.p. 30–35.

3

O’Brien, S., Day, C., Black, E., Theford, C., & Dolan, K. (2006) ‘Injecting Drug Users’ Understanding of Hepatitis C’, Technical Report No. 262, National Drug and Alcohol Research Centre (NDARC), The University of New South Wales: Sydney.

4

National Centre in HIV Epidemiology and Clinical Research (2009) ‘HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia’, Annual Surveillance Report 2009, National Centre in HIV Epidemiology and Clinical Research (NCHECR), The University of New South Wales: Sydney, p.13.

5

Australian Government Department of Health and Ageing, op. cit., p.16.

6

Ibid.

7

Higgs, P., Kelsall, J. & Nguyen, Q.C. (2008) ‘Transitions to Injecting & Risk of Hepatitis C Transmission Among Ethnic Vietnamese Heroin Smokers in Melbourne, Australia’, Journal of Hepatitis Monthly, 8(2), p.p. 115–120.

8

AIVL — Australian Injecting & Illicit Drug Users League (2004) National Snapshot on Hepatitis C Transmission Risks Among Injecting Psychostimulant Users, AIVL: Canberra, p. 29.

9

Australian Government Department of Health and Ageing. op. cit., p. 21.

10

National Centre in HIV Epidemiology and Clinical Research (NCHECR) (2010) ‘HIV, viral hepatitis and sexually transmissible infections in Australia’, Annual Surveillance Report 2010, University of New South Wales: Sydney.

11

Ibid

12

Maher et al, op. cit.

13

Iverson J., Topp L. & Maher, L. (2011) Australian NSP Survey National Data Report 2010, The Kirby institute, University of NSW: Sydney.

14

Bryant, J., Wilson, H., Hull, P., Lavis, Y. & Treloar, C. (2010) Drug use, hepatitis C and exposure to injecting among young people in New South Wales: The Big Day Out Survey 2006– 2009, National Centre in HIV Social Research, The University of New South Wales: Sydney.

15

Brener L., Spooner C. & Treloar C. (2010) Preventing transitions to injecting amongst young people: What is the role of Needle and Syringe Programmes? International Journal of Drug Policy 21, p. 160–164.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

16

Smith, A., Agius P., Mitchell, A., Barrett, C. & Pitts, M. (2009) Secondary Students and Sexual Health 2008, Monograph Series No. 70, Australian Research Centre in Sex, Health & Society, La Trobe University: Melbourne.

17

Treloar C., Abelson J., Crawford J., Kippax S., Howard J., van Beek I., Copeland J., Weatherall A. M. & Madden, A. (2003) Risk for hepatitis C: Transition and initiation to injecting drug use among youth in a range of injecting drug user networks, Monograph 8/2003, National Centre in HIV Social Research, The University of New South Wales: Sydney.

18

Australian Institute of Health and Welfare (AIHW) (2008) 2007 National Drug Strategy Household Survey: First Results, Drug Statistics Series Number 20, Cat. No. PHE 98, AIHW: Canberra.

19

Ibid.

20

Sindicich, N. & Burns, L. (2011) Australian Trends in Ecstasy and Related Drug Markets 2010: Findings from the Ecstasy and Related Drugs Reporting System (EDRS). Australian Drug Trend Series No. 64, National Drug and Alcohol Research Centre, University of New South Wales: Sydney.

21

Matthews, A.J. & Bruno, R. (2010) Mephedrone use among regular ecstasy consumers in Australia, EDRS Drug Trends Bulletin, December 2010, National Drug and Alcohol Research Centre, University of New South Wales: Sydney.

22

National Centre in HIV Epidemiology and Clinical Research (2010), op. cit.

23

Smith et al, op. cit.

24

Ibid.

25

Richters J. (2008) Oral Sex and Young People, Social Research Briefs, Number 9, National Centre in HIV Social Research, University of New South Wales: Sydney.

26

Smith et al, op. cit., p. 17.

27

AIVL (2004), op. cit., p. 27.

28

Richters, op.cit.

29

Smith et al, op. cit.

30

AIVL (2004), op. cit.

31

Iverson et al, op. cit.

32

National Centre for HIV Epidemiology and Clinical Research (2009), op. cit.

33

Centre for Youth Drug Studies (2005) Social marketing and prevention, Prevention Research Quarterly: DrugInfo Clearinghouse: Melbourne.

34

Burnet Institute (2008) SMS 2008 Project Summary, Burnet Institute: Melbourne.

35

Mayock P. (2005) ‘Scripting’ risk: Young people and the construction of drug journeys. Drugs: Education,

Prevention, and Policy, 12(5), pp. 349–368.

36

ibid

37

Moore D. (2011) ‘Pathologising young adults who use alcohol and other drugs…again: In search of an alternative view’, Centre Lines, 33.

38

Ibid pp. 2–4.

AIVL’S National Youth BBV, STI & Drug Use Project – Scoping and Consultation Report

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39

United Nations Educational, Scientific and Cultural Organization (UNESCO) (n.d), Online: Available, http://www.unesco.org/new/en/social-and-human-sciences/themes/social-transformations/youth/ strategy/, Accessed 25 March 2011.

40

The Danish Youth Council, (nd), Online: Available, http://duf.dk/english/about_duf/, Accessed 15 May 2011.

41

Australian Institute of Health and Welfare (AIHW) (2008) op. cit.

42

Matthews & Bruno, op. cit.

43

Ibid.

44

National Centre in HIV Epidemiology and Clinical Research (2010), op. cit.

45

Iverson et al, op. cit.

46

National Centre in HIV Epidemiology and Clinical Research (2010), op. cit.

47

Hopwood, M., Holt, M., Treloar, C. & de Wit, J. (Eds.) (2010). HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour, Monograph 4/2010, National Centre in HIV Social Research, The University of New South Wales: Sydney.

48

Australian Institute of Health and Welfare (2008), op. cit.

49

Bryant, J., Wilson, H., Hull, P., Lavis, Y. & Treloar, C. (2010). Drug use, hepatitis C and exposure to injecting among young people in New South Wales: The Big Day Out Survey 2006–2009. Sydney: National Centre in HIV Social research, The University of New South Wales.

50

Ibid.

51

Ibid.

52

Brener et al, op.cit.

53

Hunt N., Stillwell G., Taylor, C. Griffiths, P. (1998) Evaluation of a brief intervention to prevent initiation into injecting, Drugs: Education Prevention & Policy 5(2), pp. 185–194.

54

Douglas, L., Snow, K., Eichhorn, S. (2010) Communications research to inform development of Hepatitis C Prevention Campaign, NSW Health Department: Sydney, p. 20.

55

National Centre in HIV Epidemiology and Clinical Research (2010) op. cit., p. 64.

56

Bryant et al, op. cit.

57

Maher et al, op. cit.

58

National Centre in HIV Epidemiology and Clinical Research (NCHECR) (2010), op. cit., p. 76.

59

Australian Institute of Health and Welfare (2008), op. cit.

60

AIVL — Australian Injecting & Illicit Drug Users League (2006) A Framework for Peer Education by Drug User Organisations, AIVL: Canberra, p. 34.

61

Treloar et al, op. cit.

62

O’Brien et al, op. cit.

63

Australian Government Department of Health & Ageing, op. cit.

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YOUNG PEOPLE: SEX, DRUGS & BBVS – DO THEY REALLY CARE?

S E

Young People: Sex, Drugs & BBVs — Do They Really Care?

X AIVL’s National Youth BBV, STI & Drug Use Scoping Report

B

V

s

4612 DESIGN DIRECTION

B

Australian Injecting and Illicit Drug Users League (AIVL) June 2011