There are many reasons why involvement of peers in developing and implementing policies and services is important and relevant:

  • involvement is a cornerstone of inclusive policies
  • it can provide direction and guidance for the development of policies and services
  • it increases coverage and impact of health and social interventions
  • it leads to better quality policies and services
  • it empowers individuals
  • it addresses stigma and discrimination



Peer involvement is part of inclusive policies

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{simplepopup link="video28"}{/simplepopup}{simplepopup popup="false" name="video28"}“There is no way that the government can develop a fair policy on drugs and health without consulting and involving us:  people using drugs.  We are the one and only real experts.”

Berne Stahlenkranz, drug activist, Swedish Drug Users Union, Sweden.






There are various reasons why peer involvement is crucial for inclusive policies:

  • First and foremost, involvement of the final beneficiaries of a policy, service or initiative is the foundation of basic ethical and human rights principles and it is imperative for health and social policy development.  It is GIPA (Greater Involvement of People who Use Drugs) par excellence. See: WHAT IS…..?/HISTORY/Greater involvement

    Peer involvement is a fundamental requirement and cornerstone of transparent and accountable policies.  Engagement of the targeted communities is beyond argument and should simply be common practice.

Peers (and the initiatives they might be engaged in) have specialised skills and knowledge that enrich the policy debate, as follows:

  • Peer organisations have access to information, experiences and perspectives that are different to those that policymakers bring to the discussion.  In addition, the involvement of peer-based local and national organisations increases the legitimacy of those organisations.
  • Peer involvement enhances democratic and transparent decision-making.  Engaging peer initiatives and peers themselves in policymaking widens the debate.
  • Peer organisations have the independence necessary to raise issues and questions that other civil society actors or governments will not and, in doing so, can act as the ‘conscience’ and the ‘watchdogs’ of the process.


The commitment made by governments in 2001 and 2006 when they endorsed the UN General Assembly’s Declaration of Commitment on HIV/AIDS and Political Declaration on HIV/AIDS calls for the greater involvement of people living with HIV and of people from marginalised communities.
This means that governments and organisations cannot claim that they involve members or representatives of the target communities adequately in their work unless they do so meaningfully, in a formal, structured manner.

An excellent description of the ethical imperative of anchoring user involvement in policies and regulations can be found in the publication from the Canadian Aids Legal Network, Nothing about us without us

In Europe, the EU Drug Strategy 2005-2012 and the EU Drug Action Plan 2009-2012 invites the Member States to improve access to drug services by  developing alliances between citizens and institutions.

These EU  documents have no specific reference to drug user empowerment and involvement.  However, the Council Recommendation of 18 June 2003, on the prevention and reduction of health-related harm associated with drug dependence invites Member States to “encourage, when appropriate, the involvement of, and promote training for, peers and volunteers in outreach work, including measures to reduce drug-related deaths, first aid and early involvement of the emergency services”.;id=2603&lang=en&T=2

Provides direction and guidance to policies and services

Peer work and peer involvement give direction and guidance to policies and services.  Peers themselves are often the best individuals to identify what works in a community that others know very little about.  Peers need to be involved in creating effective responses to situations and needs.  They have access to first-hand information, experiences and perspectives from the communities and from personal experiences.

Peer involvement will also greatly assist in the identification of needs, the design of recommendations and in the planning of service delivery.  By involving peers, the agency gains buy-in from service users and their wider community.

“People who use illegal drugs have demonstrated they can organize themselves and make valuable contributions to their community, including: expanding the reach and effectiveness of HIV prevention and harm reduction services by making contact with those at greatest risk; providing much-needed care and support; and advocating for their rights and the recognition of their dignity.”

Ralph Jürgens in ‘Nothing about us without us’, Open Society Fund






Increases coverage and impact of interventions

Peer work creates an opportunity to reach and support people outside the regular service boundaries. Peers’ operations are based on people’s own level of understanding, inside the communities, where they actually live.
Peers are able to reach people where others have not had access before, in places that are unknown or unfamiliar to non-drug-using (outreach) workers. Peers are able to communicate more effectively with their community members than non-peer workers, because they speak in the same jargon and know the culture and codes. The trust that is therefore built up is an important base upon which support work can be built.

“When they know that we’re community health nurses, our program gets incredible respect – when they think that we’re just ex-users off the street who feel like doing this job because we want to give back to the community, we lose the respect for what we do.  The community doesn’t see a value in users being part of the program and they don’t recognize that someone who is currently using has much to contribute.”

Toronto Harm Reduction Task Force:  Peer Manual - A guide for peer workers and agencies




Most importantly, peers have credibility. They share background, habits and rituals and their ‘street respect’ is an authentic and genuine.  This provides peer workers the ability to provide trusted information and support to their colleagues.  People in the community recognise that ‘they’ve been there’ and are more likely to believe and trust the information they receive.  Peers have been shown to be an important, trusted referral route into formal services.

Thus, peer work provides an alternative to the traditional ‘provider-client’ model.



Improves quality of services

Peers are a useful resource when assessing the relevance, credibility and quality of the management of a service.

Peer workers as the critical link between a service and the target communities can determine the success or failure of that service.  Peers’ natural contacts in the community can provide the service with first-hand information on (changes in) community cultures and behaviour that are unable to be properly understood by ‘non-peer professionals’.



Empowers individuals

Peer work provides strong direct and indirect benefits to those who are involved.  It may stimulate positive life skills, leadership skills and may create opportunities for employment.  It also empowers individuals as they are trying to gain stability in their own life.  In addition to offering purpose and direction, peer work may raise the self-esteem and self-efficacy of the peers and the people they work with.


Peer work gives people the opportunity to gain stability, to get in the driver’s seat of their own life.

Peer work invests in people’s skills, beliefs and support networks.

For further reading, see an interesting good practice guide on social capital and peer work in HIV/AIDS by the Alliance and the Global Network of People Living with HIV (GNP+).

Challenges stigma

Peer work is an instant challenge to stigma and discrimination. From voluntary peer involvement in a service delivery up to high-level advocacy, it is a direct challenge to the numerous formal processes that exclude people from mainstream life.

Peer work directly addresses the stigmatisation, discrimination and marginalisation of vulnerable populations.  It simply shows a completely different reality.  It is based on people’s experiences and existing capacity, rather than their limitations, needs and problems. Peer work is a clear demonstration of ‘the power of peer’