RESUMEN
Despite advances in understanding the structural contexts in which drug use occurs and shifts beyond the individual-level focus of adult education theory, peer education models remain wedded to questions of individual behaviour. Our analysis examines the structural context of peer education and its implications for peer training. People who inject drugs (PWID) were invited to participate in a series of three focus group discussions in order to develop peer education messages and strategies. These were then trialled by participants within their networks and their experiences discussed in subsequent focus groups. The influence of structural factors (such as the policing of public space) on participants' peer education attempts were identified and discussed. We propose that despite the damaging impact of structural factors on the lives of PWID, they can in turn be used by peer educators to develop innovative interventions designed to increase resilience and reduce internalized stigma. Peer education programmes need sufficient flexibility and resources to allow for the negotiation of participants' immediate needs and for collaborative learning between PWID and peer educators. This would require an informed and responsive funder-a challenge to the current orthodoxy wherein peer education is increasingly delivered in formats predetermined by the funder.
Asunto(s)
Educación/organización & administración , Educación en Salud , Hepatitis C/prevención & control , Grupo Paritario , Adulto , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del SurRESUMEN
Blood awareness messages have been used for some years in hepatitis C prevention efforts. However, hepatitis C prevention education has achieved only limited success. Innovative means of reaching people who inject drugs (PWIDs) are required. This study involved video recording injecting episodes of 13 clients of the Sydney Medically Supervised Injecting Centre in Kings Cross. Participants were interviewed the following day and asked to review their video and comment on their injecting practice. Also, feedback was provided to the participants on injecting technique and hepatitis C prevention. A peer researcher was present and engaged the participant in discussion around safer practice and explored the participants' explanations of their practice. This analysis provides information about the common aspects of "safer" and "unsafer" injecting technique observed in the video recordings. Unsafer in this context was defined as any practice which could cause harm including blood borne virus transmission risks, vein damage and introduction of other pathogens to the blood stream. Analysis of the video data show that common "unsafer" practices which have implications for blood borne virus transmission include: not washing hands before injecting; using fingers to stop bleeding; wiping injection site with swab (instead of applying pressure) to stop bleeding after injecting; and using the same swab to wipe another site. Analysis of interview data provided participants' explanations of their practices. Analysis of the discussions between the interview team and the participant provides insight into the types of messages and communication strategies which had credibility with the participants. These data show that broadening of hepatitis C education discussions to include other aspects of "safer" injecting can be useful in engaging experienced PWIDs in prevention. Embedding blood borne virus prevention messages in discussions about vein care may provide innovative ways to reinvigorate hepatitis C prevention efforts and impart these messages in a context which acknowledges the skills and knowledge of experienced PWIDs.