AIDS, Drugs, and Prevention: Perspectives on Individual and Community Action

By Tim Rhodes; Richard Hartnoll | Go to book overview
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Chapter 13

Peer-driven outreach to combat HIV among IDUs

A basic design and preliminary results

Jean-Paul C. Grund, Robert S. Broadhead, Douglas D. Heckathorn, L. Synn Stern and Denise L. Anthony

AIDS prevention efforts in the United States for out-of-treatment injection drug users (IDUs), other than a small number of activist-inspired needle exchanges, have relied almost entirely on a ‘provider—client’ model called ‘street-based outreach’. The model consists of hiring a small number of community members, usually ex-users or people with street credentials, to contact and work with members of their own community as clients. They do this by going to neighbourhoods as ‘outreach workers’ (OWs) for the purpose of distributing prevention materials and information to IDUs, and recruiting them to various programmes and services, including research interviews conducted by social scientists.

In the first part of this chapter, we show that IDUs’ responses to outreach efforts have been unexpectedly positive and have gone well beyond the expectations of being mere clients. Their responses indicate that future AIDS prevention efforts could well be based on a model that relies on an active collaboration with IDUs, and rewards them for working with their peers to reduce their risks of contracting and spreading HIV. We show that such a model would draw upon and strengthen the sharing rituals and norms of reciprocity that underlie and sustain user networks. Second, we describe the elements of such a prevention model, called a ‘peer driven intervention’ (PDI) (Broadhead and Heckathorn, 1994), which is based on the theory of ‘group mediated social control’ (Heckathorn, 1990). Third, we share some ethnographic data on the implementation and workings of a PDI recently started in the eastern United States. We conclude by discussing the potential of a PDI in addressing several other public health problems that involve ‘hard to reach’ populations who, like IDUs, could be expected to respond effectively to rewards for helping their peers help themselves.


Research indicates that IDUs, on their own, began taking steps to protect themselves from the spread of HIV before governmentally sponsored outreach efforts began in the United States in 1988. For example, Des Jarlais et


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