This master thesis (2015) identifies best practices for involving former and current PWUD in outreach and harm reduction activities of public health organisations. Based on interviews with 20 using and non-using members of public health organisations in eight different countries, this study provides recommendations for improving peer involvement in the health sector.

Executive summary


In the realm of harm reduction, there is the emerging practice of public health organisations involving their target populations in the functioning of their organisations in a variety of ways, via campaigning, supporting, and advocating. This particular type of outreach is known as peer involvement. This study focuses on three under-served groups: gammahydroxybutyric acid (GHB) users in the Netherlands, men who have sex with men (MSM) both nationally and abroad, and injecting drug users (IDU) internationally. These populations are under-served and thus require new approaches for outreach workers. The research question was: What are the best practices currently used to get former and current drug users organised and involved in outreach and spreading harm reduction techniques in a meaningful and effective manner? The aim of the study was to provide Mainline with recommendations on how to improve and extend their peer-to-peer based health practices.


Twenty semi-structured qualitative interviews were conducted with members of public health organisations connected to peer involvement, both peers and non-peers. Subthemes emerging from initial analyses of participants’ accounts were grouped into broader themes: agendas, guidelines, challenges, lessons learned, and organisation.


The GHB use setting was characterised by practical and ethical issues that made finding the best practices of harm reduction in this setting complex. MSM peers demonstrated a unified network. However, the poly-substance use and HIV status associated with this setting complicated how peers went about minimising risks and connecting with their target audience. The IDU setting appeared to be the most successful with regard to peer involvement.


Knowledge and trust are vital components of effective harm reduction and risk communication. Ideally, peer workers and target audiences should share a similar agenda with regard to their ideas about harm reduction. Peer involvement is largely unexplored and can be complicated, but can also be highly beneficial for both the agency, the peers, and the target group, and should therefore be encouraged.

Key words: thesis, PWUD, best practices, health, peer involvement

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