Peer Co-Production in Syringe Exchange Programs

Background/Purpose: Syringe exchange programs (SEPs), which provide unused needles to intravenous drug users (IDUs), have been crucial in reducing the global spread of HIV/AIDS, Hepatitis C, and other bloodborne diseases since the 1980s. In addition to allowing individuals to obtain syringes free of charge and dispose safely, these programs have been a safe space for IDUs to receive necessary services, increase social support, and decrease perceived stigma. SEPs were started primarily by current and former IDUs in order to provide an alternative approach to drug use outside of abstinence: as such, early volunteers and staff were almost entirely peer-led. Nevertheless, as the SEP field has seen increased professionalization and acceptance at the policy-level, SEPs have progressively employed more non-IDUs at their organizations. Using peer co-production, the mechanism of hiring individuals with lived experience, this paper asks the following: What are the needs of SEPs that affect their hiring practices of IDU and non-IDU staff? and How do peer and non-peer employees at SEPs collaborate on service provision?

Methods: Using semi-structured open-ended interviews, I propose to interview 20 employees (10 frontline and 10 managerial) at SEPs across the state of Michigan. Michigan is a useful case study, as the legality of SEPs in Michigan is dependent upon municipality. While the state of Michigan provides grants to SEPs, municipalities can decide whether SEPs can legally serve clients in their area. Using a combination of inductive and deductive coding of qualitative data, the interviews will be used to explore benefits and tensions incurred through hiring of peer versus professionalized staff.

Hypotheses: Previous research shows SEPs are still heavily staffed by current or former IDUs. I hypothesize that the need to be competitive for government and foundation grants has led to an increase in the hiring of non-IDU staff. This is because the requirements and expectations of obtaining grants has become increasingly professionalized, and no longer can SEPs survive with volunteer staff and shoestring budgets. Non-IDUs have traditionally been found on medical staff, but their role as administrators has been expanded considerably, in light of the increasing expectations of SEPs. SEPs may differ on the level of tension between current/former IDUs and non-IDUs in regards to perceived power and decision-making within the organization. I hypothesize respondents will experience difficulties in intra-organizational collaboration between IDUs and non-IDUs. As SEPs’ leaders may be pressured to hiring professional staff over staff with lived experience, staff with lived experience may feel marginalized and sidelined in regards to their legitimacy and respect at the organization.

Conclusion/Implications: By understanding the needs of SEPs and their varied hiring practices, this research considers how peer and non-peer employees at SEPs have navigated their roles as frontline service providers and managers in SEPs. As such, this research assesses how employees contend with the disparate roles and expectations that peer and non-peer staff have had at the organization. This work seeks to further understand how professionalization and increased acceptance of SEPs can affect peer co-production among service providers, in both service and advocacy contexts.