1. From Peer to Infinity Engaging Peers as Partners in Needle Exchange

2. Mat Southwell & Tam Miller AKA: Mr White & Mr Brown Private sector training, consultancy and research service run by and for people who use drugs. Teams unique selling point is its dual professional and experiential expertise. Special focus on emerging drug trends. GST plays a role described by Dr Sloboda from NIDA as bridge-building – fostering communication and learning between academic, practice and using communities.

3. Overview Secondary Needle Exchanges - HOTs Hit Squads – Mat Southwell From underground peer needle exchange to professional partnerships – the drug user group experience – Tam Miller From demons to angels – the role of drug suppliers in delivering peer needle exchange – advisor Nikki Coe

4. The East London Experience - Context 1989 (HOT founded in 1991) High levels of poverty & 40% black & minority ethnic communities High drug prevalence exacerbated through housing policies 5% HIV rates but migrant trends from Latin EU Countries, Scotland and Ireland Very under-developed services in late 1980s – mostly medical drug dependency units and no community services Emergence of new drug trends

6. The Niddrie Experience - Context From 1986 High levels of concentrated poverty - Edinburghs poorest scheme High prevalence of injecting, particularly Temgesic (low dose buprenorphine), heroin and benzos 50% HIV rates reflecting police restrictions on injecting supplies in 1980s and pattern of group sharing At time services very limited and based in city centre and only during office hours. Needle exchange bus didnt arrive until 1992

7. The Niddrie Experience - Interventions Informal sourcing of sterile injecting equipment – peer sharing Illegal needle exchange – home and community based – operating within Niddrie Mutual aid formalised with launch of Chemical Reaction user group in 1993 with Issues of Substance magazine User group chair employed as Drugs Development Worker for Castle Project between 1995 to 2002 Return to informal needle exchange after service relationship ends

8. The Niddrie Experience - Lessons Ability of people who use drugs and their organisations to respond to community-level threats with or without drug services Partnerships with drug services sustained while they are effective – partnership working is not a goal in and of itself but can be helpful Privileged-access into closed drug scene Working in a deep community – reach and impact Informal secondary exchange continues but reduced conversation with drug services

9. The North East Essex Cautionary Note Mid-1990s - heroin and amphetamine sulphate main drugs of choice with strong injecting profile Given the semi-rural area in the villages and towns around Colchester and Clacton peers, mostly drug suppliers, were engaged to deliver secondary needle exchange Peer programme championed by Community Outreach Worker hosted in Health Promotion Post was re-integrated into drug services when key post holder left losing commitment to secondary needle exchange Police subsequently targeted, arrested and imprisoned most of the supply network involved in scheme

10. Peer Needle Exchange - Shared Lessons Merits of secondary needle exchange in closed drug scenes Ability of peer needle exchanges to reach cultural sub-groups who may be out of contact with services Particular benefits of reaching women who injected drugs Engaged with trends and risk behaviour at coal face supports work around harm reduction innovation Positive focus for work of drug user groups Sustained involvement of peers beyond formal service

11. Grassroots Response to Anthrax Crisis

12. Contact details Tam Miller Gold Standard Team & Chemical Reaction tammllr@yahoo.co.uk 07922 860042