Models, experts and mutants: Exploring the relationships between peer educators and injecting drug user clients, in Delhi’s harm reduction programs

Abstract

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.

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

“…Peer distribution of services and commodities was mentioned in nineteen studies and consistently linked to the delivery of harm reduction education [ 40 – 47 , 50 , 51 , 53 – 58 , 65 – 67 ]. Concerning direct service provision, peers operated hotlines and distributed condoms, needles and syringes.…”

“…Marshall’s third category, peer support, counselling and referrals was described in sixteen studies [ 40 – 42 , 44 , 45 , 47 , 49 – 51 , 54 – 58 , 62 , 64 ]; and included peer support groups, counselling and peer navigation, and providing social and economic support. This was usually done in tandem with harm reduction education and direct service provision.…”

“…Four studies articulated the role that peers play as that of a ‘bridging’ role, where peer workers act as a bridge between clients and programmes [ 40 , 41 , 49 , 58 ]. Because of their knowledge and experiences of common practices across social contexts, peer workers are able to link together the different ‘worlds’ of clients and services and undertake a process of mediation, managing differences and tensions.…”

“…Three studies discuss the ‘role model’ mechanism in describing how peer roles function [ 41 , 55 , 58 ]. In this role, peer workers draw on their personal experience to provide mentoring advice and model behaviours for peers to follow.…”

“…Clinic and service delivery environments are mentioned in ten of the review papers [ 40 – 43 , 46 , 47 , 49 , 55 , 58 , 67 ]. The studies went on to describe the challenges, including a lack of trust in health services, the costs of healthcare and lack of funding and political will for harm reduction.…”