Reaching Drug Users: A Toolkit for Outreach Services

This International HIV/AIDS Alliance guide provides tips on how to do outreach work among communities of people who use drugs, in particular among injecting drug users (IDU). It includes suggestions on how to optimise the number of clients served by each outreach worker, in order to ensure cost effectiveness.

The guide includes the following topics: reducing HIV risk among IDU, outreach workers, points of service, models of outreach, reaching people, good practice, capacity building, safety in outreach, evaluation, and how to begin. Key resources and key messages are highlighted throughout.

The International HIV/AIDS Alliance launched the Community Action on Harm Reduction (CAHR) project in 2011. Partners in China, India, Indonesia, Kenya, and Malaysia use a community outreach approach but have found a lack of information materials on outreach among people who use drugs. Partners confirmed the need for a guide and suggested topics to be included.

Evidence shows that outreach using peers has been effective in reaching drug users and providing them with the means to adopt safer practices. The guide emphasises the need to involve people who use drugs in outreach, not only as service providers but also in the assessment, planning, and evaluation of the intervention. This responds to the Alliance’s good practice standard: “People who use drugs participate in our programming and decision-making.”

Outreach is a client-oriented and community-based method that makes contact with clients and provides health and social services in communities and households where there is a need, including reaching the hard to reach, who may not access mainstream services due to the possible illegal nature of drug use.

Outreach may include commodities to support safe and sterile injecting conditions. It might include educational information on antiretroviral therapy (ART), as well as drug dependency treatment and services for tuberculosis and other kinds of infections. It may provide counselling, legal services, and referrals to services, self-help groups, and rehabilitation, as well as overdose prevention.

Outreach workers may be professionals and/or community members. The document recommends involving community members in planning. When active or former drug users are involved: "Active or former drug users often know better how to reach people who use drugs. They may be more likely to understand the language and norms of the local drug scene, to have informal contacts with potential clients, and may be able to build more trusting relationships with people who use drugs than professionals can. Their personal experience of drug use gives them credibility among other drug users and access to high-risk sites. They can also serve as a role model to other drug users. But there are some risks as well. Former drug users have a danger of relapse into drug use, especially during constant contact with active drug users. Outreach workers who use drugs may confront problems with the police, and there are possible difficulties with following the schedule of working hours, so they may require extra support from their organisation."

Points of service may include: the street (ambulatory outreach), a mobile unit, or a fixed site. This guide describes four outreach models:

• the indigenous leader model in which outreach workers, trusted by peers, act as key opinion-leaders among their peers;
• community-based outreach model in which outreach workers serve as role models, educators, and advocates;
• peer-driven intervention, recruiting drug users to work with their networks; and
• secondary needle exchange, a model of needle and syringe exchange where people who use drugs receive a large number of clean syringes and needles for distribution among their peers.

The document describes kinds of locations for encountering clients and various ways to establish contact. It lists good practices in outreach, particularly focused on being flexible, non-judgemental, honest, and attentive. There is a list of topics for capacity building with outreach workers and how to build support mechanisms for them to do their work. Safety measures are discussed, as well as confidentiality standards. For monitoring and evaluation, outreach worker information is critical for estimating numbers, defining the demand for services, assessing worker capacity, and reporting targets reached, among others. Some organisations provide codes for clients to preserve anonymity. For example, daily registers, referral records, and coupons for needle exchange can all be used for evaluation data. A section of the document is dedicated to outlining steps for programme start-up. The document describes uses of communication media throughout, for example, printed information for ambulatory outreach workers and mobile phone hotlines for client contact.