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Prevention Among Injection Drug Users

 IDU HIV Prevention
Outreach to
Drug Users

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HIV Prevention Among Injection Drug Users

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U.S. Department of Health and Human Services

Archival Content: 1999-2005

Training Doing the Work

Peer-Driven Intervention (PDI)

In the traditional outreach model, an organization’s paid staff members—often trusted community members or former drug users—are the outreach workers. Studies conducted during the 1980s and 1990s showed that IDUs often help these outreach staff carry out their prevention work. IDUs help introduce the outreach workers to new communities and distribute prevention materials. They also help outreach workers locate very high-risk, hard-to-reach injectors.

In the past 10 years, this involvement by IDUs has led to the development of a new outreach model, called peer-driven intervention (PDI). This innovative social network model relies entirely on IDUs to carry out the major outreach functions. IDU outreach workers locate their peers, provide education and information, and help peers obtain services and treatment. The IDUs work closely with health educators who are trained to conduct HIV testing and refer users to health care and other services.

PDI differs from other outreach models because the IDU workers are paid a small sum for each peer they recruit. This is the way it works: Each IDU worker is offered 2-3 coupons for use in locating and educating drug-using peers and recruiting them to come to a storefront HIV prevention facility. When the peers go to the storefront, they turn in their coupons and are given a knowledge test to see how well they were educated by the IDU workers. The worker is paid a small sum of money for each peer they successfully educate and recruit to the storefront. The peers who come to the storefront then become IDU workers and are offered 2-3 coupons to educate and recruit other peers.

PDI has several strengths:

  • Because each IDU worker recruits several peers who then recruit other peers, PDI can reach a large and diverse group of IDUs who might not be reached by traditional outreach methods. Example: 4 IDUs who get 3 coupons each can recruit 12 peers. If those 12 peers get 3 coupons each, they can recruit 36 peers, and so on.
  • Getting money for each successfully educated and recruited peer is strong motivation for IDUs to reach out to their own peers and spread prevention messages.
  • Repeating HIV education messages to several peers helps IDUs become more knowledgeable about HIV risk and prevention. Involving IDUs in prevention work also helps them reduce their own HIV risk behaviors.
  • Because IDUs in the PDI model are working “on commission” rather than on a salary, PDI can be much less expensive than traditional outreach.

A small number of studies have shown that PDI can reach more drug users than traditional outreach at less cost and that it can reduce high-risk behaviors and improve HIV knowledge among IDUs. Researchers are continuing to test and refine the model in a variety of settings here in the U.S. and in other countries. This research and continued use in communities will help reinforce these initial findings.

Useful Resources

  • Broadhead RS, Heckathorn DD, Altice FL, van Hulst Y, Carbone M, Friedland GH, O’Connor PG, Selwyn PA. Increasing drug users’ adherence to HIV treatment: results of a peer-driven intervention feasibility study. Social Science and Medicine 2002;55(2):235-246.


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