Peer-based harm reduction – an essential step in the fight against hepatitis C?

By Dee Cunniffe, Policy Lead with the London Joint Working Group on Substance Use and Hepatitis C

We are living in a time of real hope for the elimination of hepatitis C, with work to find and treat hepatitis C bringing about a 43% fall in cases in England since 2015. NHS England even suggest the country is on track to eliminate the virus as a public health threat by 2025. However, new infections and re-infections remain a challenge, and necessitate a new and more accessible approach to harm reduction for people who inject drugs. In 2021, this led the London Joint Working Group on Substance Use and Hepatitis C (LJWG) and Hackney Council to begin exploring a new model of needle and syringe provision (NSP), to be guided by peer workers, volunteers and service users.

Research has found that needle and syringe programmes can both reduce the numbers of people contracting hepatitis C and save the health system money in terms of treatment costs. But for them to work they need to be both consistently supported from public health budgets and, crucially, delivered in a way that makes them accessible and relevant to those who most need them. One of the most common ways to access needle exchange in the UK is through community pharmacies, but focus groups the LJWG ran in London with people who inject drugs highlighted problems of stigma and accessibility with existing provision, and the need for a new approach.

For example, people in the focus groups explained there are practical barriers in terms of the locations of participating pharmacies, opening hours and the availability of the right kinds and amounts of injecting equipment. However, a more striking finding was the active stigma that NSP users encountered in pharmacies. Some reported being told “don’t look at anything, don’t touch anything” by staff or simply called their experience “degrading”, raising the likelihood that they might avoid these services. On top of this, participants in the groups and experts we spoke to reported even drug treatment services were mixed on whether they offered accessible NSP. New data from the UK Health Security Agency suggests that about a third of people who inject drugs do not report having access to adequate needle and syringe provision, likely because of these ongoing problems.

Focus groups, along with experts working in health and drug treatment that we interviewed, instead identified the need for a peer-based harm reduction hub, designed and run with involvement from those who have lived experience of drug use or hepatitis C. This approach also draws on international evidence about peer-based exchanges, notably from New Zealand. Such a hub will aim to be a welcoming space, where people could access the equipment they need and receive support from peers who understand their circumstances. Needle and syringe exchange and blood-borne virus testing would be key services, but as the life needs of people accessing these services are often broader, signposting to medical treatment or guidance around housing, benefits and mental health will also form part of this vision.

Funded by Hackney Council through its drug, homeless, rough sleeping and ADDER Accelerator programmes, the LJWG is currently working with Council commissioners and NHS England to find a community space in Hackney to establish the hub. Plans are being developed by a Strategy Group, formed with representation from both providers and commissioners, and a mirror Service User Strategy Group, so that service users can design and shape the service. We hope to open the hub this year and create a powerful new example for other places to follow.

For more info or to get involved, contact and read our report, ‘Scoping project:  a peer-based needle exchange in London’.


Dee Cunniffe has been the policy lead for the London Joint Working Group on Substance Use and Hepatitis C (LJWG) since June 2009. The LJWG set up the strategic programme lead for the Routemap to eliminate hepatitis C in London. Her previous experience is in the management of substance use services including prescribing services, day programmes, residential rehab, needle exchange and harm reduction services. Among other projects the LJWG produced recommendations for hepatitis C in London, reported on housed homeless testing during the pandemic, peer based needle exchange and run projects testing for hepatitis C in community pharmacy.