4. A personal timeline (i)
1970-1980 NL: Rising drug use, urban scenes, mild repression,
abstinence-only, policy makers ignorant, prerogative of policy @
psychiatrists and social workers;
1980: Rotterdamse Junky Union (RJB), Nico Adriaans, Raising
Hell, challenging politics, making voices heard (press strategy,
Radio Junkiebond), Union Style self-organization;
1980s: Normalization policy, new generation policy makers, RJB
guerilla methadone program, introduction of low-threshold
methadone in Rotterdam, blooming chasing culture at house
addresses; onset of decrease in injecting prevalence;
5. A personal timeline (ii)
1985-1988: HADON, community based outreach to IDUs, from
methadone to needles, “sign of the times,” first needle exchange in
Rotterdam;
1986: Client Zero, “collective exchange,” 1989: 60.000 (half of
city’s) needles exchanged, natural organization in drug using networks;
1988-1993: Academia and back to the streets, observed
“frontloading” and how hardening drug policy gave birth to
crack, started to grasp the complexity of the streets, Drug use as
a social ritual. Nico (CFW) was my eye opener, Charlie Kaplan
made it all possible;
1993-1995: Go West, Group-Mediated-Social Control, the first
peer driven intervention (PDI), Respondent Driven Sampling
(RDS) in Ct, USA;
6. My experience with self-organization
Union Style self-organization, “fight (and negotiate) the
power,” guerilla activism, immediate cause important
(street user more prone to activism than methadonian),
questions about sustainability, cooptation;
Service provider to clients;
Natural organization: IDU networks organized around
critical commodities (drugs, needles, etc.), supplied by
service provider (excl. drugs of choice)
A shot of mathematical sociology: how we all use our
influence to serve our needs, economically, bio-socially,
information-wise…
7. A personal timeline (iii)
1995-2003: Go East, main occupation harm
reduction policy stuff in CEE;
Part-time researcher:
1995: “A heroin epidemic in Macedonia,” HOPS, Skopje
1999- 2000: Roma, drugs & HIV (disenfranchised
community devoid of service provision);
1999- 2000: Needle exchange in CEE (Pskov, Yaroslavl);
All studies strengthened my conviction of the need
for empowerment and peer-led strategies;
10. Pskov, 1999: Response
Both Pskov and also Yaroslavl (PDI) kept HIV under IDUS,
in contrast with most of the rest of Russia, under control.
11. RDS & PDI: Theory and Practice
Group Mediated Social Control;
From Theory to Practice
Respondent Driven Sampling;
Peer Driven Intervention
12. Group mediated social control
A theory about how people behave and
influence (negotiate) each other in order to serve
their needs, we have preferences regarding both
our own and other people’s actions;
Two sources of social influence:
Individual sanction based control—primary
incentives;
Group mediated social control—secondary
incentives;
Example: The school class dilemma
13. Figure 1. The theory of Group-Mediated
Social Control (Heckathorn, 1997)
Individual Sanctionbased Control
Sanctions can be both
positive and negative
Individual
Sanction
Group-Mediated
Social Control
Actor
Agent
Collective Sanction
Intra Group Control
(e.g. spill-over from
individual Sanction)
Actor’s Group
14. From Theory to Practice (i)
Network approach applying positive incentives:
Primary Incentive for participation in intervention;
Secondary Incentive for engaging peers in
intervention;
Recognizes that peers know best about peers,
peers are better to convince peers than
professional workers
15. From Theory to Practice (ii)
Research: Respondent Driven Sampling
Peers are rewarded to convince their peers to join
the study;
Modified snowball sampling;
Mathematical model, based on GMSC, allows for
assessing and correcting bias: probability sample.
Coupon system for tracking and payment
16. Figure 2. Respondent Flow in RDS
Flow of
incentives
Flow of
incentives
Research Worker
Peer 1.1
Peer 1
Community
Research
unit
Peer 2
Research
unit
Peer 1.2
Community
Seed 1
Research unit
Peer Y
Community
Peer 1.Y
Seed 2
Seed X
Peer Y.1
Peer Y.2
Peer Y.Y
Peer 1.1.1
Peer 1.1.2
X = No. of seeds;
Y = 3-5
Peer 1.1.Y
17. What’s good for science…
Question: how long does it take
an outreach worker to get from…
Sample composition stabilizes,
reaching equilibrium independent of
the choice of seeds. Recruitment by
race/ethnicity, NYC drug users
(Abdul-Quader et al., 2006)
B
A
18. From Theory to Practice (iii)
Intervention: Peer Driven Intervention
Peers are rewarded to conduct the same tasks as
outreach workers;
Primary incentive for participation in a series of
health education sessions (accent on being taught);
Secondary incentive for engaging peers in
intervention and educating them in the community
(accent on teaching);
20. Is “What’s good for science,” good
for the People?
Peer driven intervention superior to traditional
outreach work intervention in HIV prevention among
IDUs:
The PDI significantly outperformed the TOI in education
performance, recruitment power, representation, and in
reducing risk behaviours, while being about 30 times less
costly.
Participants respond positively, rewarding contributes to selfesteem, stimulates networking and information flow, no
noticeable effect on drug use.
Repeated studies have supported findings
21. A personal timeline (iv)
2004: Ukraine: respondent driven sampling
study of young IDUs and their non-injecting
friends about transition into injecting drug use
2006: CVO research line: New applications for
RDS and the PDI.
2007: The Hague Department of Public Health:
WEB-RDS
22. RDS : new directions
WEB-RDS of 1500 Nightlife
participants at The Hague
Department of Public Health
23. PDI: new directions (iii)
Ukraine “transition into IDU” RDS study
Initiation into IDU is peer-based social process, different for boys
and girls, exposure to IDU events leads to curiosity, curiosity kills
the cat…
Follow up proposal: Peers Breaking the Cycle intervention (PDI),
aiming to reduce the incidence of injecting drug use;
Ukraine (Other countries?)
Two target groups: young/recent IDUs, non-IDU friends;
Two approaches:
Non-IDUs: social marketing PDI aiming to strengthen social norms
against injecting;
IDUs: PDI combining Break the Cycle & overdose prevention (Naloxone)
Targets two of the gravest health concerns associated with
(injecting) drug use: HIV & overdose
24. Conclusions (i)
Social theory supports community and peer based
interventions;
Innovation in intervention development is important;
Group mediated social control is useful concept for
community based interventions;
Applied in various vulnerable (IDUs, non-IDUs, CSW,
MSM) and less vulnerable populations (recreational
drug users, nightlife participants, Jazz musicians);
Participants respond positively to PDI & RDS;
Peer driven interventions enhance self-esteem,
engagement and “solidarity groups” (Heckathorn &
Rosenstein, 2002).
25. Conclusions (ii)
Need to study GMSC applications in different populations and
towards different intervention goals;
Netherlands: smokable cocaine users on the street;
Ukraine (and elsewhere?): prevention of initiation of drug injecting
Treatment PDI
Is model useful for community organizing approaches in
vulnerable populations?
Positive action
Conveys useful ‘user knowledge’ & health information
Rewarding
Empowering
Possible recruitment pool for community activism and other forms of
organizing around health, social and human rights issues?
