Reducing harms in the work environment - Recommendations for employing and managing peers in harm reduction programmes in South Africa

By Rafaela Rigoni

People who use drugs (PWUD) are key actors in harm reduction programmes, playing critical roles, well beyond being a target group. There is growing recognition of the need for meaningful involvement of PWUD in all aspects of relevant policy and programme development. PWUD have the right to participate in decisions that influence their lives and are the real experts when it comes to harm reduction. Substantial evidence confirms the crucial added value peers bring to harm reduction programmes. People with lived experience of drug use help to access and build trust with clients, increase the active engagement of PWUD in care, and are building bridges between the clientele and essential services. Moreover, the meaningful involvement of PWUD in harm reduction programmes brings benefits for users themselves: from learning new skills to improving their own selfcare and self-esteem.

The PWUD community has been essential in the development and growth of harm reduction programmes. South Africa is one of few countries that meaningfully included and paid peers at the start of the harm reduction projects. Peers were actively involved in designing, shaping, implementing, and evaluating the existing harm reduction programmes in the country. They provided input on local, provincial, and national level policies and plans to improve their health and rights. In contrast, many other countries include peers only as volunteers with no financial reimbursement. South African programmes have led the way in recognizing peers financially. Although drug use is still criminalized, South Africa has seen tremendous progress in acknowledging harm reduction, which was achieved by meaningfully involving the PWUD community.