HIV Australia | Vol. 13 No. 3 | December 2015
By Christine Kerr and Rosie Gilliver
The Kirketon Road Centre (KRC) is a primary health care facility based in Sydney’s Kings Cross, established in April 1987, as a result of a recommendation of the New South Wales Parliamentary Select Committee on Prostitution.KRC provides prevention, treatment and care for HIV/ AIDS and other transmissible infections among ‘at risk’ young people, sex workers and people who inject drugs, as well as innovative outreach programs to youth services, strip-clubs and sex-parlours in the local area.
In addition, the KRC conducts nightly mobile outreach to those living and/ or working on the streets of East Sydney, Woolloomooloo and Darlinghurst.
Many of the clients engaging with HIV prevention services in these local innercity settings identify as Aboriginal and/or Torres Strait Islander people.
Indeed, in 2015, almost 10% of KRC’s clinical work and 37% of the clients enrolled in its Opioid Substitution Treatment harm reduction program identified as Aboriginal, Torres Strait Islander or both.
This compares favourably to the latest census data, which shows Aboriginal and Torres Strait Islanders make up only 1.3% of the local government area population.1
Within this population group, there is a similar prevalence of HIV as the general population at KRC.2
Additionally, 50% of KRC’s services are provided to people with a history of injecting drug use, and of those, 50% are living with chronic hepatitis C.
Since its establishment, 10–15% of KRC’s clients have identified as Aboriginal and/or Torres Strait Islander (hereafter referred to as Aboriginal people).
In 1996, KRC undertook a needs analysis in acknowledgment of the specific health, social and cultural needs of this client group, the findings of which recommended the appointment of an Aboriginal Health Educator.
Since then, KRC Aboriginal Health Project Officers have fulfilled an important health education and community outreach role, building links in the local Aboriginal community to increase access to KRC for HIV prevention, medical and psychosocial services.
In 2003, a further needs analysis was undertaken with Aboriginal clients accessing KRC to further identify specific needs of the community. It was apparent that while some Aboriginal clients were visiting KRC on a daily basis for the Opioid Substitution Treatment program, others were irregularly attending for drug and alcohol support and drop-in.
As a group, the needs analysis identified that Aboriginal clients were reticent about accessing further services, especially sexual health services.
In 2004, the Itha Mari Aboriginal Health and Healing Group was established in response to clients’ requests to establish an Aboriginal group that could meet regularly to voice and focus on their health needs and other concerns.
Itha Mari, from the Barkindji language, meaning, ‘this way in the right direction’ was proposed by a Barkindji woman who attended the group, and was unanimously agreed on by all participants as a true reflection of their expressed goals.
Itha Mari supported Aboriginal clients who were experiencing challenges related to drug use, general medical and psychosocial health and wellbeing.
Clients were encouraged to play an active role within Itha Mari so that KRC staff, in collaboration with clients, could identify barriers, work together to dismantle them, and improve access to the service.
The importance of Itha Mari lies in empowering clients to participate in decision making relating to their health outcomes, as well as in facilitating their reconnection to their countries, their cultures and their languages.
Since the program’s conception, Itha Mari has included weekly luncheons with Aboriginal Elders and guest speakers, targeted health promotion activities, cultural excursions, literacy and art projects and, more recently, storytelling.
These groups have all been very different, but all held common goals: promoting and encouraging confidence and self-esteem, sharing knowledge and experience, giving expression to individual needs, exploring feelings and preferred futures, reflecting on themselves and their communities, and rebuilding connections.
Throughout the duration of the program, there have been many collaborative community activities undertaken by Itha Mari, including the creation of a beautiful panel for the inaugural Aboriginal and Torres Strait Islander AIDS Memorial Quilt, participation in cultural field trips and art sessions, the development of a literacy program in collaboration with Tranby Aboriginal College, contributions to the National Drug Strategy through Koori Radio3 and community celebrations during NAIDOC Week – including the annual smoking ceremony and KRC Koori Film Festival.
The specific health promotion activities coordinated by KRC for Koori clients have included women’s and men’s health groups, mental health awareness, sexual health and drug and alcohol focus groups, healthy liver discussions, harm minimisation and healthy relationships sessions.
Poster for Smoking Ceremony held at the Medically Supervised Injecting Centre (MSIC), November 2008.
Three significant cultural projects in which KRC clients have participated are described in greater detail below.
Aboriginal and Torres Strait Islander AIDS Memorial Quilt
In 2004, Itha Mari clients were invited to create a panel that would become an integral part of the inaugural Aboriginal and Torres Strait Islander AIDS Memorial Quilt.
The clients participated in this project with much respect and commitment and developed the design to:
‘… represent all of us, protected by the Rainbow Serpent whose eggs represent new life and rebirth. The boomerangs in the four corners of the panel represent the return of the spirits to the Rainbow Serpent’s eggs.
‘The smoke from the burning gum leaves is our spirit and our healing. It also represents those who have passed on. The coloured hands and feet represent our togetherness and together, we stand. The flag represents our proud nation. The willy-wagtail and the symbol of the AIDS virus represent the bad news AIDS brings.
‘The central yellow sun represents a brand new day and hope. The river running across the panel represents our different paths and different tribes joined together. There is no beginning and there is no end to this river … WE SURVIVE.’4
KRC clients attended the inaugural unfolding of the quilt at La Perouse with great pride at being present to honour those for whom the quilt was created and for whom deep loss was felt.
Literacy program
In 2007, Tranby Aboriginal College and KRC, partially funded by the Indigenous Coordination Council, delivered a Literacy program to KRC clients each fortnight over a period of ten months.
The project was developed after a KRC staff member was asked by a client of Itha Mari to help her learn to read and write ‘well enough to fill in a form’. Education is one of the strongest indicators of health success.
KRC, as a comprehensive primary health care service, and Tranby, as Australia’s oldest independent Aboriginal adult education provider, jointly applied for a network model based on the shared goals of strengthening the skills and improving the capacity of Aboriginal clients.
Tranby’s and KRC’s aim was to improve the ongoing development of Aboriginal communities’ capacities through: improving literacy skill levels of Aboriginal clients; strengthening partnerships with Aboriginal clients, as stakeholders with government and non-government agencies; increasing the level of awareness of Aboriginal issues as they impact on health and wellbeing; encouraging participation within a secure and safe framework to further enhance and build individual confidence and self-esteem; and increasing opportunities for consultation between clients and educational and health providers to develop programs that directly reflected their needs.
The project was an outstanding success, not just for the gains in literacy but for the gains in clients’ selfesteem and self-determination.5
Storylines
At the start of 2015, a new initiative within Itha Mari was introduced. The Storylines initiative was based on the evidence-based practice of traditional yarning circles being utilised as a therapeutic tool for clients to engage with one another in order to reconnect with their countries, cultures and languages.
These reconnections and strengthening of belongings in turn have had the capacity to improve health and wellbeing.6
The Aboriginal Elder David Wright, who worked as an Aboriginal Park Ranger with National Parks and Wildlife, attended this Itha Mari Storylines Group and led the yarning with tales of his work, his culture and his family, stressing the importance of good health and the links between health and Aboriginal self-esteem and Aboriginal community benefit.
Uncle Dave also spoke of his broader life experiences and the importance of connection to country and culture. He shared and educated clients through his knowledge and skills with bush tucker and bush tools and implements.7
All these shared activities were invaluable for clients who had been raised within urban environments and who felt that they had lost many connections to their lands, their cultures and communities.
Within Itha Mari, Storylines clients shared a range of narratives which differed in type and purpose, but which could clearly provide participants with a mechanism to manage current life transitions and recurring unresolved issues associated with loss, grief and trauma.
In supporting clients to build connections to countries, cultures and communities, utilising the tradition of storytelling, Itha Mari allowed clients to share experiences of resilience, strength and courage.
Itha Mari has been supported and publicised through the publication of exquisitely beautiful fliers and posters developed in conjunction with the clients attending Itha Mari. At the clients’ requests, these posters have incorporated their spirit animals/totems with vibrant colours reflecting powerful images of country.
As well as empowering clients to access KRC, Itha Mari has been strongly linked to workforce development of KRC staff.
Itha Mari has provided a platform for cultural competency and cultural respect training and has also kept Aboriginal clients’ health issues at the forefront of KRC’s service development and strategic planning as well as fulfilling the wider NSW Health strategies to improve health outcomes for Aboriginal peoples.
Significant challenges have presented as Itha Mari has evolved. However, with the determination of the participants and ongoing staff input and support, these challenges have been met with innovation and commitment, unfortunately though, not always with success.
The clients attending Itha Mari reflect the high rates of mortality and morbidity within the broader Aboriginal community. These statistics continue as a shameful reminder of the continuing social, economic and political injustices with which Aboriginal peoples are faced daily.
For KRC to continue to provide innovative and relevant programs for Aboriginal clients, there is ongoing commitment, assessment and evaluation of each of them, whether delivered within KRC as a health promotion activity or on outreach to The Wayside Chapel or the Medically Supervised Injecting Centre.
In conclusion, an affirmative program such as Itha Mari that is client-centred and promotes client self-determination, allows an environment of Aboriginal clients’ confident participation in the service and the opportunity for positive health outcomes.
For staff working under the banner ‘health for all’, Itha Mariremains an inspiration and provides for deeper understanding of KRC’s Aboriginal clients and their stories of strength, courage, resilience and survival.
Acknowledgements:
Brian Doyle and Miki Griffiths – Aboriginal project officers; Aboriginal and Torres Strait Islander clients of Kirketon Road; Gadigal people of the Eora nation, on whose land Kirketon Road Centre staff work; and all staff and clients of the Kirketon Road Centre.
References
1 Australian Bureau of Statistics. (2011). Australian Census 2011. Community Profiles. Retrieved from: http://www.censusdata.abs.gov.au
2 The Kirby Institute. (2015) HIV, Viral Hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2015. The Kirby Institute, UNSW Australia, Sydney.
3 Koori Radio 93.7FM (2LND) is a community radio station serving Sydney’s Aboriginal and Torres Strait Islander communities, operated by not-for-profit Aboriginal community organisation, Gadigal Information Service. The term Koori, from Awabakal language, gurri, are the Aboriginal/Torres Strait Islander peoples that traditionally occupied modernday New South Wales and Victoria.
4 November 2007, Itha Mari participants’ description of KRC panel contribution to inaugural Aboriginal and Torres Strait Islander Quilt.
5 Black, S., Ndaba, A., Kerr, C., Doyle, B. (2012). Methadone, Counselling and Literacy: A health Literacy Partnership for Aboriginal Clients. Literacy and Numeracy Studies, 20(1), 45–62.
6 Bessarab, D., Ng’andu, B. (2010). Yarning About Yarning as a Legitimate Method in Indigenous Research. International Journal of Critical Indigenous Studies, 3(1), 39–44.
7 Hurstville City Council. (2014). Oatley Park from an Aboriginal Perspective. Retrieved from: http://www.hurstville.nsw.gov.au/Aboriginal-Resources.html
Rosie Gilliver is Projects Manager/Clinical Nurse Consultant at Kirketon Road Centre (KRC).
Christine Kerr is Counsellor/Project Officer at KRC.