Structural constraints on the training of peer educators in hepatitis C prevention

Abstract

Despite advances in understanding the structural contexts in which drug use occurs and shifts beyond the individual-level focus of adult education theory, peer education models remain wedded to questions of individual behaviour. Our analysis examines the structural context of peer education and its implications for peer training. People who inject drugs (PWID) were invited to participate in a series of three focus group discussions in order to develop peer education messages and strategies. These were then trialled by participants within their networks and their experiences discussed in subsequent focus groups. The influence of structural factors (such as the policing of public space) on participants' peer education attempts were identified and discussed. We propose that despite the damaging impact of structural factors on the lives of PWID, they can in turn be used by peer educators to develop innovative interventions designed to increase resilience and reduce internalized stigma. Peer education programmes need sufficient flexibility and resources to allow for the negotiation of participants' immediate needs and for collaborative learning between PWID and peer educators. This would require an informed and responsive funder-a challenge to the current orthodoxy wherein peer education is increasingly delivered in formats predetermined by the funder.

‘It's Fast, It's Quick, It Stops Me Being Sick’: How to influence preparation of opioid tablets for injection

“…Social and political institutions, along with individuals, have responsibility for promoting and enabling harm reduction . Peer education has been identified as a key response in reducing transmission of blood‐borne viruses ; however, peer education should also be used in promoting safer injecting practices to improve individual health outcomes (such as vein and organ care). Organisations working with PWID should collaborate with clients in developing health promotion messages that benefit all aspects of drug users' health and wellbeing.…”

Tensions in relation: How peer support is experienced and received in a hepatitis C treatment intervention

“…Compounding this, functions of peers that have been highlighted in previous research were sometimes taken on by nurses and drug services staff. The role was often reduced to limited educational exchange (of the individualistic kind -see Treloar et al, 2011) and chaperoning clients to treatment, rather than helping them prepare for and assisting during it or "facilitating referrals" (Treloar et al, 2015: 996).…”

“…Treloar et al (2011) have previously highlighted restrictions on the availability of social space beyond drug clinics for peer education and support. Our study finds restrictions on space within drug clinics too.…”

“…Much of this previous research has been done with little critical reflection on how social structures, policies, health and drug services and social identity impact on the ways in which peer support is experienced and received (Treloar et al, 2011). A recent systematic review (MacLellan et al, 2015) of peer support workers' experiences across all health contexts found only one study reporting on the perspectives of HCV peer workers (Norman et al, 2008) and it appears only one study has been published since ; both originate from Australia.…”

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

“…Mitra, Rachlis (21) reported that 32% of potential SCS clients want assisted injection as a standard, operational feature onsite. Peer-based approaches to drug use have proven cost effective and beneficial to the most vulnerable members of the intravenous drug using cohort (22), and peer education is known to be an effective measure against the spread of blood-borne infections (23). A formalized, peer injection support program could benefit SCS clients through safe injection education and expert assistance, while protecting recipients from exploitive or unsafe relationships with would-be injectors (14).…”