The National Needle Exchange Forum hosted an ‘Open Session’ at the National Conference on Injecting Drug Use (NCIDU) in Glasgow on Monday 26th October 2009. The session was run by the Gold Standards Team and entitled ‘From Peer to Infinity: Engaging Peers as Partners in Needle Exchange Delivery’.
It was completely full – with well over 150 participants – and received great feedback from those that attended.
Even with the UK’s developed needle and syringe programmes (NSPs), the UK is still only giving out enough injecting equipment to cover a fraction of the total number of injections. Globally, countries have committed to securing ‘Universal Access’ to harm reduction services by 2010 and it is unclear if this can be achieved with the continued reliance on fixed site needle exchanges and pharmacy needle exchange schemes. While both models of NSP have their benefits, they also have in-built and unavoidable problems with regard to access given the issues around location, fears of exposure, and opening times. Even mobile needle exchange schemes do not avoid these problems and in fact opening times will normally be even more restricted even if the number of delivery sites increases.
Around the world people who use drugs and people who sell drugs have played key roles in getting injecting equipment out to people who inject drugs. However, the UK has limited experience with such models and even where secondary needle exchange is deployed it is often informally done or achieved through workers turning a blind eye to the practice.
However, three parts of the UK did successfully deploy a mix of peer based approaches to extending the range and reach of NSP programmes. The experiences in North East Essex, East London and Edinburgh are very different in terms of context and delivery models. However, they all show that peers can be successful partners when properly engaged. Peer needle delivery can extend the volume of equipment being exchanged, and it has been shown to secure access into inner city housing estates, dispersed rural areas and importantly it allows for the engagement of a much more diverse population of injectors than accessed by traditional needle exchange programmes.
Importantly, peer-based needle exchange offers access to harm reduction services without the risk of exposure involved in formal service entry. This has been shown to be particularly effective in reach women, parents who use drugs, recreational injectors and other ‘hard-to-reach’ populations.
The evidence-base for this work is limited, and the experiences within the UK are restricted mostly to the 1990s. The National Needle Exchange Forum, however, can help to put peer exchange back on the agenda. This seminar, run by the Gold Standard Team, provides a unique opportunity to hear the experiences of these three pioneering projects with a view to sharing and disseminating best practice to the current generation of NSPs and needle exchange workers through the NNEF, and possible even developing draft policies and guidelines.