Peers in the Pandemic: Examining the Experiences of Harm Reduction Peer Outreach Workers in New York City during COVID-19 Using Photovoice

Background

The ongoing overdose crisis compounded by the COVID-19 pandemic has severely impacted the health and well-being of people who use drugs (PWUD) in New York City, especially PWUD of color. The need for social distancing has led more individuals to use drugs alone and increase usage, heightening the risk of fatal overdose. Additionally, the pandemic has threatened economic security and increased barriers to accessing harm reduction and treatment services. Despite these obstacles, harm reduction peer outreach workers (people with lived experience of drug use) continuously delivered essential services to PWUD in their communities. The purpose of this study was to partner with peers through community-based participatory research to understand and advocate for the needs of PWUD in NYC during and beyond the pandemic.

Methods

Three researchers (one with lived experience of drug use and longstanding ties to the NYC harm reduction community) and six peers (recruited through a harm reduction agency) collaborated on this photovoice project. Photovoice relies on photographs taken and described by community members to document and advocate for community needs and assets. After two virtual planning meetings, the team developed the research question, “What are the experiences of harm reduction outreach workers and people using drugs during the COVID-19 pandemic in NYC?” In five subsequent virtual meetings, the team reflected on peers’ photographic representations of their experiences. These sessions were audio-recorded and transcribed, using thematic analysis to organize and interpret findings.

Results

Peers on average had over 5 years of experience in harm reduction and served predominantly Black and Latinx communities. Themes that emerged included: 1) barriers to peer work, 2) developing trust with PWUD, 3) links between drug-user health and broader community health, 4) peer social support, and 5) self-care. Peers expressed deep compassion for the PWUD they serve. Concurrently, peers voiced distress about drug user health and safety concerns that are exacerbated by the pandemic, pervasive social stigma, and discriminatory drug policies. Nevertheless, peers emphasized that sharing social identities with the PWUD they serve allows them to foster trusting relationships and provide services that PWUD might not otherwise receive. In turn, the peers reflected, providing these services to PWUD has broader implications for community health and safety. Additionally, peers shared their gratitude for social support from their colleagues and the importance of self-care practices, both of which aid their conviction and capacity to serve the community during the pandemic despite being grossly under-resourced and under-funded.

Conclusion/Implications

This study demonstrates the effectiveness of partnering with peers on a photovoice project to identify the needs of PWUD, better understand barriers and facilitators to service provision, and ultimately work to promote equity. Historically, PWUD have been excluded in research, policies, and programs that directly impact them; our findings reveal the essential need to partner with peers in work that aims to support PWUD, as their expertise brings novel insights that are especially impactful. Results highlight the need for increased funding for peer-based harm reduction services, education initiatives to combat stigma against PWUD, and anti-oppressive drug policies.