In the street

Outreach is an important approach in providing services to the community.
It has had a particularly important role in providing HIV prevention and other health education and support among people who use drugs.

Outreach can be conducted by current drug users, former drug users or by people with close links with drug user networks.

Outreach - reaching out - is getting out of the office and contacting, informing, educating and supporting people in the community. It is a very good way of providing health promotion messages, distributing prevention materials and equipment (such as condoms and syringes), and facilitating access to specialised services, such as testing and treatment for sexually transmitted infections (STIs) or referral and consultation for antiretroviral therapy (ART).

All the major international health agencies (WHO, UNAIDS and others) have recommended outreach as an essential core component and a proven effective approach in conducting health promotion activities among drug users.

The WHO’s Evidence for Action recommends outreach as an excellent approach for contacting drug users in their local neighbourhoods and providing specifically tailored, effective health support services.

A specific task of peer involvement is overdose prevention.  Drug users are trained to recognise and adequately act if a peer shows signs of an overdose:  an important peer intervention.  In a naloxone (opioid antagonist – an antidote) distribution programme, health educators or physicians train heroin injectors, individually or in injecting partnership pairs, to treat peers with naloxone in case of overdose.  Examples include:

A study on naloxone overdose prevention in the USA, from Bruce et al.(2001).

And in the UK, a study from Best et al. (2002).

Outreach is a strategy that follows early public health traditions of health professionals canvassing communities offering health information and treatment.  The success of outreach work has been due to the hiring and training of individuals who are indigenous to the community:  peers.  By using peer workers, programmes acquire instant credibility and access to communities who might otherwise not receive information from outsiders. This is especially true for overdose prevention, HIV, sexually transmitted infections and viral hepatitis infections among injecting drug users.

Outreach to drug users started in response to epidemic levels of heroin use in the US during the 1960s.  By the late 1960s, outreach programmes began operating in several western European countries, Australia and New Zealand, targeting drug-using youth.  Some of these programmes included targeting drug-using homeless people and street children.

Community outreach work has now become mainstream and is a core component in health promotion activities conducted all over the world.



The value of peers in outreach

Outreach work is frontline work.  It takes place at grassroots level. The face-to-face contact through outreach is the critical moment for interaction between agency and community.  It is the moment where the outreach worker can adjust and tailor his/her message and deliver information according to the specific needs and requirements of the targeted individuals.  Peers, and other trained people from the community, are very good in this job.

Peer outreach is considered more effective than outreach without peer involvement. 
Peer outreach can:

  • Reach more people and increase coverage of services.  Peers know the ways to communicate and access their community.  Peer outreach work has the ability to effectively reach more people, more diverse groups of people and those who live on the fringes of the community.
  • Have bigger behavioural impact.  Peers know the language, codes and the culture, the best ways of raising and discussing certain health issues and how to offer meaningful, healthier alternatives.

“Peer outreach programmes are particularly effective at accessing hard-to-reach drug users and providing relevant, credible HIV-related information and commodities.” HIV/AIDS Alliance, Good Practice Guide



Peer-driven interventions

Peer education and support are effective strategies for e.g. HIV prevention among drug users. My research suggests that such efforts dovetail neatly with natural mechanisms of social support. From the streets of New York or Moscow to the pastures of rural Connecticut or Pskov, I have seen that peer action is a rewarding and empowering experience!

Jean Paul Grund, researcher, The Netherlands






A specific structured way of conducting peer outreach is an approach that recruits peers and their friends as health educators, known as a peer-driven intervention.  Peers are recruited, trained and sent out into the community to educate their friends.  The method often uses a voucher system as an incentive for peer educators to establish new contacts.
This model isn’t 100% peer-based or peer-led, as peers are mainly used as messengers of a fixed message.  In addition, the design, management and evaluation of the initiative is conducted by non-peers.  Despite these limitations, peer involvement in this model may be effective in educating people and raising awareness of services.

For instance in the Ukraine, this method led to significant results:
“Beginning with only six “seeds” (individual drug users), the project reached 900 new drug users in six months. The model was then scaled up to increase the number of sites, and in seven months 17 projects reached 16,920 drug users who had been unaware of services.” (source: HIV/AIDS Alliance

Further reading

There are many manuals and guidelines on outreach work, including:

Two resources focusing on the European context, both produced in the framework of the Correlation Network are: