Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low‑ and middle‑income countries
From the beginning, people who use drugs have been central to the development and delivery of HIV and harm reduction programmes. Communities, advocates, service providers and health professionals have all called for increasing the meaningful involvement of people who use drugs within HIV and harm reduction programmes, and research focused on high-income settings indicates positive outcomes in service reach, accessibility and quality when peers are meaningfully involved.
However, this research often overlooks the specific operations and contexts for peer-involved programming. Furthermore, there is a gap in research pertaining to the impacts of peer involvement in low and middle income settings. This lack of discourse has fueled a split between high-level support for peer involvement and the limited role of peers in practice; put simply, the lip-service given towards the importance of peer involvement is too often just that when it comes to practice and real-life settings.
This rapid review written for the Harm Reduction Journal, conceived and written by INPUD’s Executive Director Judy Chang, Andy Guise and Shaun Shelly along with community and civil society leaders examines available literature with the goal of critically assessing the evidence in support of increasing peer involvement in low and middle income settings. The findings of this rapid review include:
- Peer involvement in HIV and harm reduction services in low and middle income settings leads to positive health outcomes.
- The context of peer involvement is shaped by contexts of criminalisation, stigma and resource scarcity.
- Peer outreach interventions work through building trust, community knowledge, and bridge mechanisms to counter criminalisation and constraining service delivery environments, in turn contributing towards decreasing stigma and discrimination as well as the quality of services.
- There is a need to expand the range of peer roles and capacity of people who use drugs within HIV and harm reduction programmes.