Paying injection drug users to educate and recruit their peers: why participant-driven interventions are an ethical public health model

Qual Manag Health Care. 1999 Summer;7(4):4-12. doi: 10.1097/00019514-199907040-00004.


The criminalization of drug use has made it difficult to reach injection drug users (IDUs) with public health interventions. The "peer-driven intervention" (PDI) makes use of the existing social network of IDUs to educate and recruit participants in the intervention. Participant IDUs are given nominal financial rewards for being interviewed, for recruiting IDUs to the program, and for educating their recruits. Using peers as educators, PDIs build a discourse of prevention in the community and contextualize those messages in daily interactions of IDUs. Some critics of the PDI model, however, have balked at the idea of providing active injectors with financial rewards that can be used to purchase drugs. This essay, which describes some of the ways that the Eastern Connecticut Outreach Project worked to avoid potential pitfalls of the reward program, defends the PDI as an ethically superior model for public health intervention.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Community Health Services / economics
  • Community Health Services / organization & administration*
  • Connecticut
  • Ethics
  • HIV Infections / etiology
  • HIV Infections / prevention & control
  • Health Education / economics
  • Health Education / organization & administration*
  • Humans
  • Models, Educational
  • Motivation*
  • Peer Group*
  • Reward
  • Social Support
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / prevention & control
  • Substance Abuse, Intravenous / psychology*