Training Guide

Peer Delivered Syringe Exchange (PDSE) Toolkit

Module 1: Peers and Programs

“We come from the ‘hood to them. A peer really needs to be someone who’s been there, done that. We know where the hot spots are..” — Anonymous Peer

Who is Involved in Peer-Delivered Syringe Services Programs?

Chances are if you’re designing or running a PDSS program, you know that the goals and benefits of a peer program are many and varied. A peer program can have a big impact on the peers themselves, the participants or clients of the program, the staff, your organization, and the broader community.

  • Peers: Peers are developing their roles as leaders and professionals. Peer programs provide an opportunity to partner with peers to improve the quality of their lives, their health, and their overall well-being. Many peers have told us that doing something that feels good for themselves and for their community has had a positive impact on their own health. Additionally, peers may be able to leverage the skills and experience gained through a peer program to obtain more permanent employment in the field.
    Persons serving as peers, rather than being legitimized through academic credentials, draw their legitimacy from experiential knowledge and experiential expertise. Experiential knowledge is information acquired about harm reduction through the process of one’s own use or being with others. Experiential expertise entails the ability to translate this knowledge into skills that can be passed on to others. Many people have acquired experiential knowledge about harm reduction, but those who have the added dimension of experiential expertise are ideal candidates for the role of a peer.
  • Participants: Peers are uniquely positioned to engage with and relate to program participants and potential program participants. Peers can offer agency participants important information with added credibility because they have “been there, done that”. Participants can benefit from seeing people like themselves in positions of leadership and strive for those positions as well.
    Peers may also have social ties with other people who use drugs who don’t know about or don’t otherwise feel comfortable access services at your program. One of the greatest benefits of PDSS is its ability to engage with networks of PWUD who aren’t otherwise linked with services.
  • Organization and Staff. your organization can benefit from the work of peers in numerous ways. PDSS leads to increased enrollments of new participants, helping your agency meet deliverables. PDSS can enhance staff development. Through peer programs, staff have an opportunity to teach and to share their skills in mentoring or supervisory roles with peers. Peers may also develop their professional skills to the point that they progress to full employment within the organization.

Purposes and Priorities of PDSS

Syringe access services programs’ primary goal is improving the health of PWUDs, so it is essential to deliberately seek the involvement of active PWUDs. Active PWUDs have insight into current cultural norms, practices, and needs among people who use drugs, and may be able to gain trust more easily from participants; Their involvement will reinforce the program’s respect for active people who use drugs.
Peer-delivered syringe access services programs can serve a number of purposes. The agencies that contributed to this toolkit all initiated their PDSS programs for different reasons. Some examples include:

  • Reaching new or underserved populations, such as transgender indivPWUDals, youth, or sex workers;
  • Tapping into existing social networks to reach PWUDs in areas where people are not currently accessing SSP services. Some programs use peers to bridge the gap between participants and SSP. however, there may be people who do not want to interact with a SSP at all and prefer to engage solely with a peer;
  • Expanding access services to clean syringes at times and dates the SSP is not open, such as evenings or weekends.

Models of Peer Programs

PDSS programs are commonly structured in three ways; most programs will use a combination of these models:

  • Storefront SSP PDSS: In this model, peers work out of an office- or storefront-based syringe access services program, during approved SSP hours, and at approved SSP locations; participants must visit the program for services. Placing peers in your storefront SSP may encourage participants to come in and connect with other services you offer. Participants may feel more at ease if a peer is the first person they see when walking into your SSP.
  • Street-based PDSS: This model refers to peers who – alone, in pairs, or with staff – do syringe access services on the street, out of vans, or while walking through neighborhoods. This option is more flexible than the storefront model in that it is not limited to one specific area. Often, under this model, peers will have set dates, schedules, and routes or areas for their work. Peers go to the participants, rather than having participants come to peers.
  • Social Network access services: This is the most informal PDSS model. Peers using this model take syringes back to their communities and distribute them whenever and wherever they want. This is the lowest threshold and least intensive model and allows peers to operate in their own space and on their own schedules. It has the most flexibility and may require the least oversight. For example, a peer keeps syringes and other safe injecting supplies in his apartment. his friends and acquaintances call him and stop by his apartment when they need supplies.
  • Delivery: PDSS via Delivery Service is another innovative model that enlists PDSS workers to engage in an on-call syringe delivery service. Delivery requests for syringes are called into either the program or the PWUD PDSS worker, and workers are dispatched to locations for syringe collection and delivery. PDSS workers may fulfill their entire hourly commitment by conducting delivery. However, these PDSS workers may also conduct SSP transactions within their social networks on their own time.

The size of a peer program depends on the capacity of your SSP and on how many peers you can effectively support at any one time. A program with fewer resources for staff may rely more heavily on peers to meet the needs of the community. However, it is important for programs to provide adequate support to PDSS peers and be cautious not to overburden them as a result of limited resources.


CASE STUDIES: Programs Using Multiple PDSS Models

Washington Heights CORNER Project (WHCP):
On a typical day, one peer in WhcP’s storefront might assemble safer injecting kits while another peer goes on a walkabout (visiting a set route during specific times with supplies) with other peers or with staff, and a third peer comes in and picks up 700 syringes for distribution to her social network. PDSS peers have provided anywhere from 22% to 64% of WhcP’s monthly unduplicated syringe access services transactions. During a recent agency relocation, PDSS peers provided 50-64% of syringe access services transactions.

AIDS Center of Queens County (ACQC):
Some peers go out to their own social networks on their own schedule while others go on walkabouts and bring participants to a van with staff inside to link them with other services; still more peers work out of the storefront during regular SSP hours.

Southern Tier AIDS Program (STAP):
STAP uses both social network PDSS and delivery. They will deliver to numerous locations, such as an individual PWUD’s home, stores, parking lots, etc. They often meet up and will then go somewhere more private to access services. Deliveries may be requested by regular contacts or arranged if someone can’t or doesn’t want to come to the storefront. The program will get the contact details and ID code or an alias, so that when the PDSS peer makes contact they can share the code or alias.


QUESTIONS TO CONSIDER – Module 1: Peers And Programs

Who Is Involved in PDSS?

  • What populations/networks do not currently access your program?
  • Do you have participants/peers that are part of/have a relationship with those networks/ populations?
  • What model/s of PDSS would be most accessible and acceptable to these populations/networks?

Purposes and Priorities of PDSS

  • Can PDSS be integrated into existing services (i.e. outreach, storefront, etc)?
  • What experience does your agency have to support different models of PDSS?
  • What resources does your agency have to support long-term PDSS?
  • How will your agency assess risk of overburdening PDSS peers?