Among, within and between:
Interview: Sue Fowles and Chris Lawrence,
AIDS Council of NSW
When Sue Fowles took the reins as the first Aboriginal women's project officer within the state AIDS council, she had to hit the ground running. She describes her time as a steep learning curve, not just for herself, but for those in the communities who are her "target groups". Sue and her counterpart, gay men's project officer Chris Lawrence, have had to become virtual cultural acrobats, challenging and confronting cultural differences at every level. Without the comfort of clearly identified 'target groups' who fall politiely into categories, they have necessarily had to reinvent how HIV education "gets done". They talk with Kirsty Machon
Position: Aboriginal and Torres Strait Islander Women's Project 0fficer
Target groups:'women at risk', positive women, lesbian and transgender people."Basically,Aboriginal and Torres Strait Islander communities."
"The position of Chris and myself is that we have a male and female worker. Traditionally, for example as at AFAO, they make a special position for an Aboriginal person. But it tends to be specifically for [an] Aboriginal gay male. I have no problems with that, obviously. But if you're going to look at AIDS councils, for a start, you really have to have two people [a man and a woman] employed, particularly if you're going to be going out into Aboriginal communities. There are going to be issues around women's health and men's health...There are some communities which have specific issues [around men's business and women's business]."
Position: Aboriginal and Torres Strait Islander Men's Project 0fficer
"My target brief is Aboriginal and Torres Strait Islander gay men, transgender people."
"Both the National Strategies have identified Aboriginal people as being the second most 'high-risk' group. Well my argument about this has been: OK, homosexually active men are number one, Aboriginal and Torres Strait Islander are number two, IDU number three...so if you're Aboriginal and all of the above..."
KIRSTY MACHON 'Women at risk' is a fairly daunting concept for a 'target group'.
SUE FOWLES Every day, I take up some of the stuff around injecting drug use, sex workers.. -What I've been doing for the last year is, because it's a brand new position, establishing that position. I've had to do a whole lot of groundwork with the key players: Aboriginal Medical Services right around the state, HIV-related organisations, networking on a national level with Aboriginal and Torres Strait lslander workers in other AIDS organisations.
KM A huge brief for one person...
SF It is. We tend to work with other Aboriginal sexual health workers. Assist them in any way in terms of the supply of resources.
CHRIS LAWRENCE Positive Aboriginal people are also my target group: be they gay, straight, whatever. We think inclusively of all Aboriginal and Torres Strait lslander people, regardless of our 'target groups'. SF We can't have a specific gay, lesbian, bisexual, target group...when the whole community is affected. It's basically looking at community development as education throughout the whole community, not just target groups.
KM Presumably, that translates into a situation where HIV is not quarantined, but is related to broader issues around providing good sexual health education through the communities with which you work.
SF Yes. [This is my observation] of how other sexual health workers, and their community programs, have worked...As a sexual health educator, they can go in and talk about issues relating to HIV. But they have to put it in a different context, it has to relate to other areas. It's hard to go into a community and just talk about HIV... It's such a confronting health issue. It's easier to talk about it [in terms of] other issues happening within communities. So if there's a high STD rate, for example, it's easier then to talk about risk factors, and into that, incorporate [information about] risk factors associated with HIV. Also, if there's high rates of [injecting drug use], we can incorporate that without just talking about HIV.
CL It's also about complementing each others' roles. As Sue and I complement each other, we also complement the sexual health workers out in the field, and other service providers. It's also dealing with the effects of living with community members, people who are [HIV positive]. How would [remote and rural communities] go about finding information about how to care for someone living with HIV/AIDS - how that affects that community, how they keep that community together. It comes down to cultural differences, economic differences. A lot of people feel they can't access those services, because they aren't deemed Aboriginal specific. Which is completely wrong. There are many services available inside ACON and other agencies...[Aboriginal] people are entitled to access those services.
KM How does this approach to care and support work in isolated communities? Presumably, they can't just dial up the Community Support Network and get someone round to sweep the floor.
SF There hadn't been any Aboriginal specific caring. [The State Health Department] has established workshops specifically for Aboriginal carers, around the issue of caring for a family member within a community context.1
You've had situations [in the past] where either a person has had to come into the city from a rural area...and not necessarily with anyone to show them around, how to access this community: very much 'stumbling'.
Also, you've got family members being carers...those folks have had no support, and can't talk about it within the community because the community has no understanding, or needs to be educated around HIV. You've had that silence. Families struggling to learn about HIV while caring for someone. There hasn't been a whole lot of sharing.
[The Aboriginal volunteer carers'workshops] are also so people are aware that there are people [from the city] who can then go out to [country communities]. That's always been the problem...rural people have always had to come into the city. There have been situations around how staff members in the hospital treat family of the people being cared for, [not] understanding that family can be extended family. There has to be some work around that: how the whole family can feel comfortable while visiting. It has caused issues: around things like visiting hours, making the room for those people so that it doesn't disrupt other people... but it's also about [hospitals] being more flexible.
CL Some of the work I've been doing in country areas has been around this. They want to know, and make it part of their services. Obviously, there may be times [Aboriginal PLWHA] have to leave [their rural communities and come to the city] with regards to treatment. But from what I've seen in the New England area [around Armidale, Glen lnnes], they've got up-to-date stuff. They're always wanting to keep in touch. They find out what the latest treatments are.
KM How does the approach you take encourage people to be less sceptical about their relationships with the health care system, given immense historical and cultural anxiety?
SF That's why we're here. And that's why they have specific Aboriginal sexual health workers. It gives the opportunity for communities to feel more comfortable, someone they can approach. [We] bridge between the community and those health providers because, yes, historically, there's a fear about going to a doctor - and historically, with blackfellas, anything which looks like'authority': whether health professionals, cops...Relationships have not been that good. And it hasn't necessarily been because of major animosity, but just because the cultural understanding hasn't been there.
CL There's still a bureaucracy which exists, though, in country towns. You have Aboriginal health workers working within public health departments. But they are still [bound] by protocol and process...sometimes, people feel intimidated by these processes. I keep reminding people that Aboriginal and Torres Strait [slander people have only been in this game for the last 31 years. It's not a hell of a long time to grasp information be educated about what it means, decipher it, to access those services. Everyone else has had it...but we've always had it 'done for us'.
It's a mentality, I guess among a lot of Aboriginal people, there's this welfare dependency... it's starting to break down, but it's going to take a long time. It's important to have [Aboriginal-specific positions], so people know that they have Aboriginal people inside those services who can decipher them, and can give them information they are entitled to.
SF If you're looking at HIV in Australia, it's only in the last five years that Aboriginal communities have been targeted. There's a major gap between [non-lndigenous people] and Aboriginal and Torres Strait Islander folks. Now supposedly, we're going to 'get up to speed' over five years! But you've had an extra five to six years of that education and exposure. So it's been a fast learning curve for the sexual health workers, and the communities they're working in. [The sexual health workers] have had to become everything.
CL There's still a strong mentality in many communities that's HIV's very much a white man's disease, and a white gay man's disease. So unless you're gay, you're not going to 'get it'.
SF It's not because of basic learning, it's because the education hasn't been there. It's not because Aboriginal people don't have this understanding, it's because no one has been out there to speak about it and target them.
CL Both the National Strategies have identified Aboriginal people as being the second most 'high-risk' group. Well my argument has been: OK, homosexually active men are number one, Aboriginal and Torres Strait Islander are number two, IDU number three...so if you're Aboriginal and all of the above...
KM That approach assumes everyone is in fixed categories...
SF That's right. And it's assuming gay Aboriginal men live in the gay community. These are all these other issues which the, as I say, 'mainstream', haven't really touched: they have specific 'target groups'.
CL There are men who have sex with men in Aboriginal communities who, under some circumstances and at some times, are influenced by alcohol. Which plays a big part in sexual assault, rape...A lot of Aboriginal people are restricted. They're not able to 'get out of' that community to find safety somewhere else. Because of cultural obligations, isolation, economic reasons, literacy...[They're not able] to tell someone within that community. How do you tell someone? I think for a lot of women there are a lot of other issues there...for a male [sexuality can be] much more dramatic, sensitive...
KM Sexual assault is also an issue for women in some communities. How can it be addressed without the accusation that you've broken codes of silence, or running the risk of rednecks picking up the story and saying: 'See, we were right all alongl
SF The common issue is sexual assault, but there are major differences between male and female sexual assault. In Aboriginal communities, if they're going to talk about sexual assault, you'd have more talk about women. The taboo is still very much male [to mile] sexual assault. The assumption [is] that males don't get assaulted. These are the myths which need to be broken down across the board in all communities.
CL I'd ask: whose definition do we go by when talking about sexual assault? That is a [question] for a lot of Aboriginal communities. What is deemed sexual assault? Who initiates it? When is it accepted and not accepted? Traditional practices which have been there for thousands of years are still in place in lots of communities around Australia. It happens in other communities...Greek, Italian, Muslim, where the female is 'given away' at birth. She's promised in marriage. There are lots of conflicts around it. In terms of Aboriginal culture, whose standards should we live by? The whole world has been living by English standards. But there are times when alcohol plays a part [in assault]. I don't accept that. But there's a fine line between what is perceived right and what is perceived wrong.
SF I have an interest in people bringing it out so it can be discussed. Of course, it's going to be a 'code of silence', as it is in all communities, black and white, when it comes to sexual assault. But we have to start talking about it. So that it does come together as something specifically targeted. We have sexual health workers, health workers, drug and alcohol workers...they don't work together. None of them network. I find that bizarre. Because the issues we're talking about at the moment are sexual assault under the influence of drugs and alcohol, yet these [educators] don't work together. That's what I, and another [Indigenous] woman who works at the Rape Crisis Centre, also with a state brief, are looking at trying to do, getting people to network, see they are not just singular issues.
KM Is it your feeling that this is starting to happen?
SF Certainly, people are talking about it. I know of a couple of sexual health workers on the south coast [of NSW] have been talking about those issues. But they're finding it hard because you have a drug and alcohol worker who doesn't necessarily work with a sexual health worker.
CL The other thing that comes to mind is the practice of [having] multiple husbands and wives. It's still very much an issue. I think this is stuff that a lot of mainstream services have really considered. When they look at southern parts of Australia, they don't see a lot of people affected by these things. [Aboriginal activist] Charles Perkins put it quite bluntly: 'Aboriginal people in the south can get on a bus, catch it to the nearest doctor. People in isolated communities, rural communities, the Northern Territory, cannot'. We have to deal with all this. We're taking into account a hell of a lot of cultural differences. I really feel there isn't a thing in this country that doesn't have an Aboriginal aspect: HIV is just another one, another issue.
KM How do you take something like the national Indigenous Sexual Health Strategy and ensure it isn't just sitting on shelves? It's all very well to have these very pretty, democratic documents, but how do you encourage people to use them?
CL This is what we talked about in Brisbane [at Anwernekenhe]: how do we get Aboriginal people to become inclusive of the issues and [services] in place. Some of the things that came out: We have to become members of our [Aboriginal Medical Services], our AIDS councils, any other kinds of incorporated agencies out there, so we can have voices who are part of the decision making. All of this social research gets done [about Aboriginals and health], all these glossy magazines are printed up. Fuck all gets done about it.
SF The position of Chris and myself is that we have [both] a male and female worker. Traditionally, for example as at AFAO, they make a special position for an Aboriginal person. But it tends to be specifically for [an] Aboriginal gay male. I have no problems with that, obviously. But if you're going to look at AIDS councils, for a start, you really have to have two people [a man and a woman] employed, particularly if you're going to be going out into Aboriginal communities to do education. Because there are going to be issues around women's health and men's health. And obviously, there are some communities which have specific issues [around men's business and women's business].
I was speaking at AFAO'S [committee meeting] specifically as the first Aboriginal woman to be employed by an AIDS council. But they have to do it differently. You can't have just one person working with the Aboriginal community. If it's a gay-identified position and you're working in a gay-identified organisation, fair enough. That's your target group. But I would like to see borders of all that stuff [challenged]. We have to realise that the Aboriginal community isn't set up like it is here...[non-lndigenous communities] have a lot more acceptance, I guess.
CL This came up at the conference, too. Who do AFAO and NAPWA represent? We've got Aboriginal representatives [on each group] - both self-identified gay and out men. They have to be inclusive of all Aboriginal people, not just gay, transgender or lesbian people. I don't know how they can do that as identified out gay men.
KM If you went into a community which may have an issue with MSM, as an out gay man...
CL Exactly. But isn't MSM about [not identifying] as being gay? How do gay men do that job?
SF If someone doesn't identify as gay, the last person they want to hear from is a gay person... It's: 'You're issues are different to mine'. We're setting people up, having people go into communities about [specific] issues, when they're trying to encompass the entire community.
CL I guess we have to be mindful too, that we've taken a long time to get to these positions. Yet HIV/AIDS has been around for...years. Aboriginal people have not been part of that [community sector development] process.
KM It seems to me whenever there is a new consultation about PLWHA or education needs that there is always this 'tacked on' agenda.
KM Everyone dutifully trots out NESB and Indigenous persons... '
SF ...and women
KM ... in this quarantined fashion. How do you address perceptions of racism in the community sector and of homophobia among Aboriginal communities?
CL It's about bridges between communities and services. And between AIDS councils, AFAO, the AMSs and government agencies. We're trying to get all these grown-up services to act like adults with each other. Everybody wants a bit of this pool of money. Organisations have to come to the party. They can employ people like us in these positions. But we're not going to bear the brunt, obviously, of everything else that is happening around internal affairs and external affairs that are happening around this pool of money.
SF Partnerships are happening between the Department of Health, the AMSs, area health...there are always going to be issues [between agencies]. Some partnerships work well, others don't. That's the stuff we have to address. I'm not coming in with a card saying: 'Hi, I'm from ACON!' It's more about talking about what issues and needs are. We have to learn how to take a different tack. We don't just go in from ACON's point of view, we'll be working through the sexual health workers who are already there. [One approach has been], if you're going to test for STDs, quite general blood tests, then you can talk about a HIV test. You give [the person] a comparison.
CL There's some isolated incidents where there have been people being tested without their knowledge. Then the agency have to deal with the consequences: Do they tell? How do they tell?
SF There have been tests without knowledge... it's unethical, obviously, and it does happen. I guess it's about giving people as much information as possible. There have been some cases, though, where people have gone out and explained [the process and implications of a HIV test]. It has seemed to work in some communities. [But] it's got to be about whole education.
CL We have to be mindful we are dealing with a lot of people who have been restricted from mainstream services for a long time. It's a big job. *
1. The NSW Aboriginal and Torres Strait Islander HIV/AIDS Volunteer Carers' Program is being run on September 14-16 1998.
The aim of the program is to ensure adequate care and support is available to Aboriginal and Torres Strait lslander PLWHA in Sydney. For information, contact: Victor Tawil, Public Health Unit, Locked Bag 11, Goulburn, NSW 2580.
ANWERNEKENHE II: Us Mob'
AMONG, WITHIN AND BETWEEN
FOR ALL AUSTRALIANS?
VAST DISTANCES...VAST DIFFERENCES
BOYS TO MEN
For more information on HIV/AIDS and Aboriginal and Torres Strait Islander people contact the Australian Federation of AIDS Organizations