People who inject drugs face significant barriers to accessing healthcare, despite having higher levels of need than the general population.
Peer workers can help break down some of the stigma and discrimination barriers in the health system and assist this marginalised population group receive the care they need.
Freya Saich and Jacqui Richmond from the Burnet Institute and Amanda Kvassay and Rebecca Kavanagh from the Queensland Injectors Health Network write below about a peer support project to help people with hepatitis C receive treatment and discuss the importance of ensuring peer workers are appropriately 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 healthcare including to people who inject drugs.
Indeed, findings from the Stigma Indicators Monitoring Project found that in 2021 nearly two in three healthcare workers reported that they would behave negatively towards other people because of their injecting drug use. Such negative interactions can prevent people from seeking the healthcare they need, leading to complications and more significant illness.
Countering stigma and discrimination
To counter stigma and discrimination, there has been a growing movement and involvement of peers across a range of services. Peer workers within mental health services have gained a prominent role but much less is known about peers who engage with people who inject or use drugs.
While definitions vary, we consider peers to be anyone with lived (past) or living (present) experience of drug use.
Regardless of the definition used, peers draw on their shared experiences to connect and engage with others. Many peers understand the challenges associated with seeking healthcare and can help others to prioritise their health needs, navigate the system and offer support, and recently, there has been an expanding role for peers in the delivery of hepatitis C care.
Eliminating hepatitis C
One example is that of QuIHN (Queensland Injectors Health Network), who received funding from the Eliminate Hepatitis C (EC) Australia partnership to deliver a peer project aiming to support people who inject drugs to access hepatitis C treatments – that can cure them of the disease. As part of the project, QuIHN employed five part-time peer workers who tested nearly 110 people using hepatitis C point of care tests and supported 25 people to access hepatitis C treatment.
To reach these people, the peer workers at QuIHN engaged with clients who were attending the needle and syringe programs run by QuIHN and attended other services that clients visited. Peer workers approached clients with an understanding of their situation and could help people work through any concerns they had about hepatitis C and available treatments.
Educating and dispelling myths
EC Australia and AIVL have also co-designed a health promotion campaign that will be delivered by peers in outreach settings to engage with people who have not accessed hepatitis C treatment and/or who are disconnected from health services. For some people who have hepatitis C they may not know that they even have the disease (given that 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 that is no longer the case with currently available treatments, while others may think that continuing to inject precludes them from accessing treatment. Peer workers can dispel these myths and link people into the appropriate services to get them tested and treated.
Other roles for peer workers
Beyond outreach services, there are also roles for peers within health services (either in paid or voluntary roles). For example, some needle and syringe programs employ peer workers who are trained in overdose and supporting the health needs of clients.
There are also opportunities for peer workers to be trained in phlebotomy especially given some people who inject drugs have poor venous access or experience significant discrimination when having their blood drawn. Similarly, integrating peer workers into traditional or mainstream healthcare services can also serve to reduce the stigma and discrimination that many people who use drugs experience.
It is vital that peer workers are not only recruited to work in such positions, but they must also receive appropriate support including supervision and management that is grounded within a peer-focused framework and receive adequate remuneration for this work.
Peer workers need to be supported to deal with challenging situations, be supported to set boundaries and navigate their role as a peer worker. Without such support, peer workers can experience burnout ultimately reducing the retention of their valuable knowledge and expertise.
Supporting the peer workforce
In addition, while peer workers can help to reduce the stigma and discrimination experienced by clients, peer workers themselves can face discrimination when engaging with services who are unfamiliar with peer workers and what they can offer.
Peer workers must be provided with adequate support to respond in 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 has worked in policy and advocacy for the past seven years advocating for systemic reform across in the disability and health sector. Freya currently works as a Policy and Research Officer at the Burnet Institute and Lead Policy Officer working on the Eliminate Hepatitis C Australia (EC Australia) Partnership. Freya works across COVID-19 and hepatitis C related projects working to translate research findings to inform and influence policy and practice and advocate for system changes.
Jacqui Richmond has worked in the viral hepatitis sector for the 25 years in nursing, education, social and health 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 broad focus of Jacqui’s work is building the capacity of the health workforce to test, treat and manage the health care needs of people living with viral hepatitis.
Amanda Kvassay has worked for the Queensland Injectors Health Network (QuIHN) as the Program Manager for the Hepatitis C testing and treatment services for the past 6 years. Amanda is a passionate advocate for equitable and accessible harm reduction services in Queensland having worked across the sector over the past 23 years. She currently works with a team of dedicated harm reduction workers, peer workers and clinical staff to implement Hepatitis C services targeted towards people who are injecting drugs.
Rebecca Kavanagh (Bec) is the Harm Reduction Coordinator for QuIHN’s Brisbane office and has been with QuIHN for 10 years. Bec has also been on the board 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 the elimination of Hep C in her community.
See here for Croakey’s archive of stories on peer workers in healthcare