People who inject drugs face significant barriers to accessing health care, despite having higher levels of need than the general population.
Peer helpers can help break down some of the barriers of stigma and discrimination in the healthcare system and help this marginalized population group get the care they need.
Freya Saich and Jacqui Richmond from Burnet Institute and Amanda Kvassay and Rebecca Kavanagh from Queensland Injectors Health Network describe below a peer support project to help people with hepatitis C get treatment and discuss the importance to ensure that peer workers are properly trained, supported and remunerated.
Freya Saich, Jacqui Richmond, Amanda Kvassay and Rebecca Kavanagh write:
For some time there has been growing recognition that health services are often inaccessible, unforgiving and even discriminatory to many people seeking care, including people who inject drugs.
Indeed, the conclusions of the Stigma Indicator Monitoring Project found that in 2021, nearly two in three healthcare workers said they would behave negatively towards other people because of their injection drug use. Such negative interactions can prevent people from seeking the health care they need, leading to complications and more serious illnesses.
Fighting stigma and discrimination
To counter stigma and discrimination, there has been a growing peer movement and involvement in a range of services. Peer workers in mental health services have gained a prominent role, but much less is known about the peers who interact with people who inject or use drugs.
Although definitions vary, we consider a peer to be anyone with lived (past) or living (present) experience of drug use.
Regardless of the definition used, peers rely on their shared experiences to connect and engage with others. Many peers understand the challenges associated with seeking healthcare and can help others prioritize their healthcare needs, navigate the system and offer support, and recently the role of peers in healthcare delivery hepatitis C increased.
Eliminate hepatitis C
One example is QuIHN (Queensland Injectors Health Network), which received funding from the Eliminate Hepatitis C (EC) Australia Partnership to carry out a peer-to-peer project to help people who inject drugs access treatment for HIV. Hepatitis C – which can cure them of the disease. As part of the project, QuIHN employed five part-time peer workers who tested nearly 110 people using point-of-care hepatitis C tests and helped 25 people access treatment for hepatitis C. ‘Hepatitis C.
To reach these people, QuIHN peer helpers spoke with clients who attended needle and syringe programs run by QuIHN and who attended other services that clients visited. Peer helpers approached clients with an understanding of their situation and could help people resolve concerns about hepatitis C and available treatments.
Educate and dispel myths
EC Australia and AIVL have also co-designed a health promotion campaign that will be led by peers in outreach settings to engage people who have not accessed hepatitis C treatment and/or are disconnected from health services. For some people with hepatitis C, they may not even know they have the disease (as it can be asymptomatic for many years).
For others who are aware of their diagnosis, they may have heard stories of past treatments that caused significant side effects with low cure rates, but may not know that is no longer the case with the currently available treatments, while others may feel that continuing to inject prevents them from accessing treatment. Peer helpers can dispel these myths and direct people to the appropriate services for testing and treatment.
Other roles for peer helpers
Beyond outreach services, there are also roles for peers within health services (paid or voluntary). For example, some needle and syringe exchange programs employ peer helpers who are trained in overdose and respond to the health needs of clients.
There are also opportunities for peer helpers to be trained in phlebotomy, especially since some people who inject drugs have poor venous access or experience significant discrimination when having blood drawn. Similarly, integrating peer workers into mainstream or mainstream health care services can also help reduce the stigma and discrimination that many people who use drugs experience.
It is essential that peer workers are not only recruited to fill these positions, but that they also receive appropriate support, including supervision and management embedded in a peer-based framework, and that they receive adequate remuneration to this work.
Peer workers need support to deal with difficult situations, support to set boundaries and navigate their role as peer workers. Without such support, peer workers may experience burnout ultimately reducing the retention of their valuable knowledge and expertise.
Support the peer workforce
Additionally, while peer workers can help reduce the stigma and discrimination experienced by clients, peer workers themselves may experience discrimination when engaging in services that are unfamiliar with peer workers and what they can offer.
Peer workers need to be given adequate support to respond to these situations, but at the same time we need to do more to address the stigma and discrimination experienced by this community as a whole.
Freya Saich
Freya Saich has worked in policy and advocacy for the past seven years, advocating for systemic reform in the disability and health sector. Freya currently works as a Policy and Research Officer at the Burnet Institute and Policy Officer on the Eliminate Hepatitis C Australia Partnership (EC Australia). Freya works on projects related to COVID-19 and Hepatitis C to translate research findings to inform and influence policy and practice and to advocate for system change.
Jacqui Richmond
Jacqui Richmond has worked in the viral hepatitis sector for 25 years in nursing, education, health and social services research, and policy development roles. She currently works at the Burnet Institute as the Workforce Development and Health Service Delivery Project Manager for the Eliminate Hepatitis C (EC) Australia Partnership. The overall goal of Jacqui’s work is to build the capacity of healthcare personnel to test, treat and manage the healthcare needs of people living with viral hepatitis.
Amanda Kvassay
Amanda Kvassay has worked for Queensland Injectors Health Network (QuIHN) as a Program Manager for Hepatitis C Testing and Treatment Services for the past 6 years. Amanda is a strong advocate for equitable and accessible harm reduction services in Queensland, having worked in the sector for the past 23 years. She is currently working with a team of dedicated harm reduction workers, peer helpers and clinical staff to implement hepatitis C services for people who inject drugs.
Rebecca Kavanagh
Rebecca Kavanagh (Bec) is the Harm Reduction Coordinator for QuIHN’s Brisbane office and has worked for QuIHN for 10 years. Bec was also a board member of QuiVAA for 5 years advocating for the rights of people who use drugs in Queensland. Bec is passionate about reducing stigma and discrimination to ensure better health outcomes for people who use drugs and eliminating hepatitis C in her community.
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