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BOX 30: Recommendations for employees who are hiring people who use drugs. 124
1. Pay attention to recruitment not only for peers but also for the staff managing peers. It is a good practice to discuss in advance with the team, involving peers and managers,
about the desired profile and skills of new staff. Involve peers in all steps of the recruitment process.
2. Offer diverse work-engagement levels like part-time, ad hoc activities or volunteering. Not everyone will be ready or willing to work full-time or in specific outreach
functions. Offering different levels of engagement with work creates opportunities for people who use drugs to progress through the organisation whilst respecting their
possibilities and needs at a given moment.
3. Promote a harm reduction approach to drug use of staff. Develop non-prohibitionist regulations at the workplace and focus on job performance instead of on drug use. What
matters is that staff needs to be fit for work and must protect the organisation’s image. They must be accountable for their performance, regardless of their eventual drug use.
4. Foster a supportive work environment. Be appreciative and promote trust-building. Provide good work conditions and support workers’ needs and self-care. Be flexible with
working hours when staff needs to attend OST or HIV/HCV/other treatment. Also, be understanding of performance problems caused by side-effects of medication, for instance.
5. Build and sustain boundaries. This implies not only being transparent about rules and how they are applied for everyone but also help to recognise, build and sustain
boundaries to help protect staff from emotional burden.
6. Promote diversity and respect within the team. Invest in team care: ensure excellent communication, team-building and promote an environment of trust amongst
colleagues. Foster the building of a diverse team and promote respect for this diversity within the team and the organisation.
7. Promote meaningful involvement of staff members who use drugs at all levels, not only on service delivery. Include staff in planning, evaluating and policy decision making.
This may mean helping to prepare staff on how to give feedback, as some might have internalised stigma, which can create additional difficulties in sharing ideas.
OST, opioid substitution therapy; HCV, hepatitis C virus.
5. Acknowledgements Ethical consideration

Additional inputs received from Lize Weich, Tanya Venter, This article followed all ethical standards for research without
Johannes Hugo, Urvisha Bhoora, Magriet Spies, Rafaela direct contact with human or animal subjects.
Rigoni, Cara O’Conner, Julia Samuelson, Viriginia
Macdonald, Michelle Rodolph, Shona Dalal, Nurain Tisaker Funding information
and Shaheema Allie. Regional harm reduction case studies
developed by Kunal Naik (PILS, Mauritius) and Bernice No specific grant was received from any funding
Apondi (VOCAL, Kenya). agency in the public, commercial or non-for-project
sectors.
Inputs from the guideline development workshop held in
August 2019 are also included. Participants of the workshop Data availability statement
included: Leora Casey, Andrew Gray, Harry Hausler, Signe
Rotberga, Muhangwi Mulaudzi, Lauren Jankelowitz, Annette Data sharing is not applicable to this article as no new data
Verster, Busisiwe Msimanga-Radebe, Nontsikelelo Mpulo, were created or analysed in this study.
Zukiswa Ngobo, Mpho Maraisane, Rogerio Phili, Kgalabi
Ngako, Maria Sibanyoni, Yolanda Ndimande, Valencia Disclaimer
Malaza, Johannes Hugo, Urvisha Bhoora and Cara O’Conner.
Specific recommendations provided here are intended
We extend our thanks to the external reviewers, including only as a guide to clinical management, based on expert
Julie Bruneau, Annette Verster, Kunal Naik, Nkereuwem consensus and best current evidence. Treatment decisions
William Ebiti and Ali Feizzadeh. for patients should be made by their responsible clinicians,
with due consideration for individual circumstances. The
Competing interests most current version of this document should always be
The authors confirm that no competing interests exist. consulted.

The views and opinions expressed in this article are those of
Authors’ contributions the authors and do not necessarily reflect the official position
All authors contributed equally to this work. of any affiliated agency of the authors.

http://www.sajhivmed.org.za 106 Open Access