The article, based on nine months of ethnographic fieldwork, explores the relationships between peer educators and their clients, under the harm reduction paradigm in Delhi, India. The study examines the way peer workers engage with their clients and manage their own recovery at the same time. The article argues three key points. First, peer educators came to be considered as harm reduction's most crucial link, they were models for the clients and their expertise about street life was invaluable for the success of the program. They adapted and expanded their roles based on client needs, despite structural and resource limitations. Second, peer educators' own struggles with addiction threatened their position within the program; it raised questions of efficacy, ethics and empowerment with regard to the peer model. Lastly, the tensions around the peer educators' role and their continued drug use, revealed larger contradictions within the Indian harm reduction model. These findings more broadly highlight the issues of peerclient relationship dynamics and peer participation in service delivery within social work.
Background
This paper examines peer recruitment dynamics through respondent driven sampling (RDS) with a sample of injection drug users in Hartford, CT to understand the strategies participants use to recruit peers into a study and the extent to which these strategies may introduce risks above the ethical limit despite safeguards in RDS.
Methods
Out of 526 injection drug users who participated in a mixed-method RDS methodology evaluation study, a nested sample of 61 participants completed an in-depth semi-structured interview at a 2-month follow-up to explore their experiences with the recruitment process.
Results
Findings revealed that participants used a variety of strategies to recruit peers, ranging from one-time interactions to more persistent strategies to encourage participation (e.g., selecting peers that can easily be found and contacted later, following up with peers to remind them of their appointment, accompanying peers to the study site, etc). Some participants described the more persistent strategies as helpful, while some others experienced these strategies as minor peer pressure, creating a feeling of obligation to participate. Narratives revealed that overall, the probability of experiencing study-related risks remains relatively low for most participants; however, a disconcerting finding was that higher study-related risks (e.g., relationship conflict, loss of relationship, physical fights, violence) were seen for recruits who participated but switched coupons or for recruits who decided not to participate in the study and did not return the coupon to the recruiter.
Conclusions
Findings indicate that peer recruitment practices in RDS generally pose minimal risk, but that peer recruitment may occasionally exceed the ethical limit, and that enhanced safeguards for studies using peer recruitment methods are recommended. Suggestions for possible enhancements are described.
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