Abstract
Abstract
Introduction
Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic.
Methods
Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts.
Results
Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O).
Conclusion
Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.
Funder
ministry of foreign affairs
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Public Health, Environmental and Occupational Health,Medicine (miscellaneous)
Reference94 articles.
1. UNAIDS Do no harm - Health, human rights and people who use drugs (2016). Retrieved August 02, 2020, from https://www.unaids.org/en/resources/documents/2016/do-no-harm
2. INPUD/UNODC Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs: practical guidance for collaborative interventions (2017). Retrieved from https://www.inpud.net/en/iduit-implementing-comprehensive-hiv-and-hcv-programmes-people-who-inject-drugs
3. UNAIDS. Health, Rights and Drugs: Harm reduction, decriminalization and zero discrimination for people who use drugs (2019). Retrieved from https://www.unaids.org/sites/default/files/media_asset/JC2954_UNAIDS_drugs_report_2019_en.pdf
4. Marshall Z, Dechman M, Minichiello A, Alcock L, Harris G. Peering into the literature: a systematic review of the roles of people who inject drugs in harm reduction initiatives. Drug Alcohol Depend. 2015;151:1–14. https://doi.org/10.1016/j.drugalcdep.2015.03.002.
5. Greer AM, Luchenski SA, Amlani AA, Lacroix K, Burmeister C, Buxton JA. Peer engagement in harm reduction strategies and services: A critical case study and evaluation framework from British Columbia Canada. BMC Public Health. 2016. https://doi.org/10.1186/s12889-016-3136-4.