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Community mobilisation | Peer workers at the heart of the response

In this video, Mat Southwell from EurNPUD talks about peerwork in harm reduction
It’s important to understand that the sale and use of drugs is criminalised, so drug scenes are organized to keep outsiders out.
Peer workers are able to bring needles, syringes and other injecting paraphernalia to the places where peers are buying and using drugs. This removes the need for peers to share used injecting equipment. Peer workers can also distribute naloxone, the lifesaving opioid overdose reversal drug within networks of people at risk through the use of heroin and other opioid drugs. Peer workers can also help community members access traditional drugs services helping to promote awareness of service options and even making informal referrals into these drugs services Peer workers from other marginalised communities can also use their privileged access to reach out through their peer networks.
This can involve distributing condoms and lubricants to sex workers or men who have sex with men, providing access to HIV testing in the community, or the promotion of life saving treatments for HIV, viral hepatitis and other chronic health conditions. Peer workers are able to provide specific advice that meets the needs of their peers because they know their peers, their risk behaviors and the settings where peers are meeting. Peer workers could also play roles beyond championing public health. This can include advising key populations about their legal rights and documenting human rights violations when these occur. This supports peer advocates to lobby for a legal enabling environment for harm reduction and also for community mobilization.
Community members normally judge the quality of services based on their experience of using these services as a client, when clients are treated with respect and dignity, then they are more likely to commit to support the work of the service as a peer worker. As clients of services make progress and achieve greater stability and balance in their lives, some will look to give back to the service and the wider drug using community. Peer workers often receive training to support them to distribute harm reduction or safer sex equipment and to educate their peers. This capacity building can further support personal change goals, helping to build and reinforce the individual’s self-esteem, self belief and technical knowledge.
Over time, volunteer peer workers will build their skills and expertise. This may allow them to receive incentive payments and over time, potentially a salaried role as community members grow in confidence and expertise so they may choose to develop a professional career in this sector. Others may self-organize with other community members in order to develop a community led organization such as a drug user group or a sex worker network.
So a key question is, does peer-led harm reduction work ? Of course, the answer is “yes”. Peer workers are effective agents for delivering harm reduction.
In 2017, I worked with MdM’s Harm Reduction Program in Kachin Myanma. I was asked to help the team expand the quality and reach of their programme through a stronger engagement with community members. Peer workers showed their ability to tackle opioid overdose and to halt the spread of blood borne viruses. They did this by reaching out through community networks to deliver equipment and knowledge to conflict zones and against the backdrop of a violent community anti-drug campaign. Local peers hosted a community ‘opioid overdose training’ in a local village that had experience 4 opioid overdose deaths in the previous week. Following the training, no one in the same village died of an opioid overdose in the following 3 months.
In the next module, I will talk more about community mobilization. But before that, here is a short film as a reminder of what peer workers do and how important they are to positive outcomes in harm reduction.
The video summarises the findings of a workshop that drew together the experience and learning around peer work with people who use drugs and sex workers. It captures the values that the organization is aiming to uphold in working with peer workers.
A peer worker is a person who uses his/her own unique expertise and knowledge from their lived experiences (such as druguse or sexwork) for the benefit of other people in similar situations. Peer-workers bring not only their experience but also their interpersonal, social and leadership skills, to build a relationship of trust and acceptance within their community and amongst their peers. Peer-worker teams reflect the diversity of the communities they are working with, with regards to gender, age, language, ethnicity or practices.
We believe that it is vital to engage with peer workers because :  It ensures that activities and solutions are adapted to the genuine needs of communities It brings together the combined expertise from the lived experience of marginalised communities and individuals with the learned experience and expertise  of medical and social professionals. It facilitates access to marginalised communities and builds trust It fosters community self-support and resilience. It contributes to the fight against stigmatisation and discrimination of marginalised populations and peers are the most legitimate to speak as a representative of their communities.
Doctors of the World recognizes peer workers as vital members of our teams.
We also acknowledge that working with peer workers can create challenges and, as an employer, we have responsibilities to guarantee their well-being : We must guarantee the meaningful participation of peer workers, beyond service provision, in all levels of project design, implementation & evaluation as well as in advocacy and decision making. We must support meaningful participation through coaching, training and adequate resources. “Tokenistic” participation can have a dramatic disempowering impact and generate long-lasting disillusion and de-mobilisation. Peer workers provide invaluable skills. And, although some peer workers may prefer to work on a voluntary basis, we should not expect these skills to be given for free.
We support fair-pay, salaried positions and appropriate working conditions for peers in recognition of their skills and their work but we oppose target-based incentives We believe in supporting peer workers’ to progress and develop in their careers they must have access to professional and personal development opportunities
Peer-workers can be exposed to many risks in their work : risks to their physical and psychological health, increased exposure to police arrest or harassment, stigma or rejection from their family or other members of society; These risks need to be jointly and regularly assessed, prevented or mitigated. For example; by providing legal support in case of arrest, salary continuation in case of imprisonment and mental and psycho-social support. Peer workers are integral parts of our teams. they share equal rights with other team members and should receive full support adapted to their needs.

In this video we will hear from Mat Southwell why and how peerworkers need to be at the heart of the response. As you have heard throughout the course, and as emphasized by many guidelines and documents; peer work is essential to do good harm reduction.

It is not about cheap or convenient workers, it is a core component of an effective harm reduction approach. However, beyond acknowledging this, how goes one about doing this right? There is no ‘one-fits-all model’ for every context, but in this video Mat will guide us through some core values that, we believe, will need to be upheld as minimum standards.

This video also features an animated video, capturing some of the outcomes of a workshop Mat has led with Médecins du Monde (MdM). It features the core values MdM aims to uphold.


We highly recommend watching the three video’s attached hereunder. They feature “a day in the life of a peerworker” from amazing and inspiring peers, working on the frontline of harm reduction in Afghanistan, Myanmar and Tanzania.

Frontline Aids and Coact created a helpful tool on how to do include peer workers in a harm reduction program with people who use drugs. You can download it here below, or follow this link.

The second part of the video above included an animated video, if you would like to use the animated video separately, you can click on this link.

We can highly recommend a simular animated video, this time from a more recent global peer work consulations workshop. You can find this here.

If you would like to dive deeper into where we stand today with peerwork peer involvement of people who use drugs in low- and middle-income countries, you will find an article hereunder. You can download it here below, or follow this link.

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Drug Use and Harm Reduction

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