A Report on Stigma and Discrimination Towards the Injecting Community Drug User Towards A Report and Discrimination on Stigma Why wouldn’t I A Report on AUSTRALIAN INJECTING AND ILLICIT DRUG USERS LEAGUE – JUNE 2011 INJECTING USERS LEAGUE AND ILLICIT DRUG AUSTRALIAN Stigma and Discrimination towards the Injecting Drug User Community 4608 DESIGN DIRECTION4608 AUSTRALIAN INJECTING AND ILLICIT DRUG USERS LEAGUE JUNE 2011 Why wouldn’t I A Report on Stigma and Discrimination towards the Injecting Drug User Community AUSTRALIAN INJECTING AND ILLICIT DRUG USERS LEAGUE JUNE 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: 978–0–9870936–3–9 Suggested citation Australian Injecting and Illicit Drug Users League (AIVL) 2011, ‘Why wouldn’t I discriminate against all of them?’, A report on stigma and discrimination towards the injecting drug user community, 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: [email protected] Website: www.aivl.org.au Published by: Australian Injecting and Illicit Drug Users League (AIVL) Layout and printing: Design Direction Contents Acknowledgements v Background to this paper vi Recommendations viii 1 Introduction 1 Why AIVL? 3 Terminology: ‘our community’ 3 2 The historical determinants of stigma and discrimination among people who inject drugs 4 The Industrial Revolution 4 The impact of statistics and the process of ‘othering’ 5 The development of professional societies 7 3 Developing the ‘disease’ 9 The temperance movement and the Protestant work ethic 10 The Opium Wars 12 The ‘problematisation’ of opiates and other drugs 14 Laws and treaties 15 Australia from 1900 to the 1960s 15 The introduction of specific policies on drug use 15 The 1920s cocaine epidemic in Australia 29 The 1930s marijuana epidemic in the United States 31 A report on stigma and discrimination towards the injecting drug user community iii The counterculture revolution and the Vietnam War 33 From reds under the beds to junkies in the cupboard: Nixon and the war on drugs 34 Disease and the fear of contagion 36 Needles and syringes as symbolic weapons 38 The media as a weapon 40 4 Stigmatisation of drug users today 42 Social theories underpinning current stigma and discrimination 44 The impact of the criminalisation of drug use 49 Passing, or getting by, in society 49 Stigma and the media 51 Drug users understanding and experience of stigma 60 Stigma and the general community 63 Stigma and the medical profession 68 5 Conclusion 72 References 74 iv ‘Why wouldn’t I discriminate against all of them?’ Acknowledgements As the principal writers for this project, Jude Byrne and Fiona Poeder particularly acknowledge the contribution of the Project Steering Committee: • Mr Justin Barker • Ms Ruth Birgin • Dr Phyll Dance • Ms Jenny Kelsall • Ms Laura Liebelt • Dr James Rowe. The committee was of enormous assistance in helping develop parameters for what is a potentially never-ending subject. Any errors in content are completely the fault of the writers. We thank, too, Ms Annie Madden, who offered a level of insight and thoughtfulness that allowed for wide-ranging and thought-provoking discussions as we tried to ‘tease out’ what was pivotal to ensuring that the document reflected our voice—the voice of the injecting drug user community. A report on stigma and discrimination towards the injecting drug user community v Background to this paper In 2009 AIVL received funding to commission market research with a view to determining the feasibility of developing a national campaign to redress the stigma and discrimination routinely faced by people who inject drugs. The primary objectives were to learn more about the perceptions of the general community—and some subsections of it, such as the medical profession—towards our community. This new information could then be used in determining how the community might respond to messages aimed at countering the misconceptions and prejudices associated with people who inject drugs. The market research report, published in 2010, was the catalyst for production of this document. The researchers found that stigma and discrimination associated with people who inject drugs are both institutionalised and pervasive. One of the most important findings was that the focus group participants—particularly the members of the general public—saw this stigma and discrimination as ‘good’ for the community as a whole. Further, participants believed stigmatising and discriminatory attitudes and actions would discourage people from taking up the practice of injecting drug use. These views were widely and strongly held, despite the wealth of research evidence highlighting the extremely harmful effects of stigma and discrimination on people who inject drugs and the lack of evidence to support discrimination as an effective deterrent to illicit drug use. The concerns raised by the market research prompted AIVL to seek further resources in order to investigate in greater depth some of the main findings before embarking on any public education campaign. In particular, we wanted to explore a range of questions from the perspective of people who inject drugs, to ask how current attitudes towards our community have developed over time and left us in a situation where we are almost universally categorised as social pariahs whose lives are of no value. We felt we needed to ‘look back’ and try to pinpoint the origins of many of these views before we could make any meaningful effort to ‘look forward’ and begin the process of challenging and changing the tired narratives that dominate injecting drug users’ lives. As a result, Chapter 2 of this document reviews the historical determinants of stigma and discrimination among people who inject drugs. It traces the history or ‘key points in time’ when attitudes towards the use of illicit drugs, the people who use them, or both, can be seen to emerge or change. As this theme develops, we increasingly focus on the question of injecting drug use, rather than broader developments in relation to all illicit drug use. Such an approach ensures that the document remains focused on the primary aim of reducing stigma and discrimination as they relate to blood-borne viruses such as hepatitis C by tackling what we believe is the main ‘driver’ of that discrimination—community attitudes towards injecting drug use and people who engage in this practice. It is difficult to single out one process or action, one definitive point in time, that can be characterised as ‘when the demonisation of people who inject drugs began’. What we have identified, however, is that the Industrial Revolution of the 19th century—a period of enormous social, cultural and economic upheaval—is one of those key points in time for tracing the development of contemporary attitudes vi ‘Why wouldn’t I discriminate against all of them?’ towards people who inject drugs. As part of understanding the impact of the Industrial Revolution, we look at a range of interrelated factors that, we argue, both directly and indirectly laid the foundations for the systematic marginalisation of people who injected drugs in the 20th century and those who do so now. Among those factors are the following: • the rapid growth of cities • the beginning of urban planning • the proliferation of factories • the development of statistics gathering and the process of ‘othering’ • the impact of immigration and the blending of new cultures, habits and practices • the rise of the medical profession and the changing status of doctors and apothecaries. This brief history of the significance of industrialism to current attitudes is further developed through an exploration of the roles of religion, trade, policy and law in shaping a deliberate process of pathologising and ‘diseasing’ people who inject drugs. Chapter 3 examines the emergence and growth of the temperance movement, the rise of organised religion and the Protestant ‘work ethic’, the Opium Wars, and the development of policy and legislation as a way to both ‘problematise’ and control the use of licit and illicit drugs. The rise of the counterculture revolution, the impact of the Vietnam War and the invention of the ‘war on drugs’ analogy by President Nixon in the 1960s and 1970s are also explored for their role in building a growing sense of fear and dislike of people who inject drugs. The chapter concludes with an analysis of several themes that feature strongly in narratives relating to people who inject drugs—the fear of contagion, needles and syringes as symbolic weapons, and the impact of mass communications on social attitudes. The final chapter offers an overview of stigma and discrimination as they are played out in contemporary society, including what it means to experience entrenched and widespread stigma and discrimination from the drug user’s perspective. A range of important social theories dealing with stigma and discrimination and injecting drug use are explored in order to link the findings arising from the AIVL-commissioned market research project with the available research and literature on this topic.