Five Hearts in China: the role of peer educators

In a quiet backstreet near the river in Emei city in Sichuan, China, a shabby teahouse is crowded as usual with locals chatting and smoking, playing cards or mah-jong over endless glasses of green tea. At first glance there is not much that sets this teahouse apart from thousands of others. A closer look reveals that a woman at one of the more popular tables has a roll of newspaper containing a bunch of syringes.

This teahouse is a key outreach spot for the Five Hearts Service Centre, an organisation of peer educators working in the community to reduce the harm of drug use, including the transmission of HIV and other infections.

Cheng Ling (not her real name) comes here to provide clean needles for heroin users. She talks about the risks and realities of drug use and explains the services that Five Hearts drop-in centre can provide, including HIV counselling and testing, methadone maintenance therapy (MMT), anti-retroviral therapy for HIV positive people and community activities.

She is in a good position to know what she is talking about. Cheng Ling is a peer educator. “If I wanted to quit heroin I had to fill my life with something else,” she says. “If I have nothing to do I’ll just turn back to drugs.” She first became involved in Five Hearts when it was set up in 2004 and has been a peer worker since 2007. “Helping others makes me feel better,” she says.

Working with authorities

Five Hearts’ goal is to build a safe environment for effective harm reduction programmes. It is run by people who use drugs, supported by Alliance China, working with the Emei Centre for Disease Control and Prevention (CDC) as well as with other local government agencies.

Working with the authorities in Emei is critical to the success of Five Hearts, as demonstrated by the fact the needle exchange programme can operate in places like the teahouse without police harassment. MMT programmes retention rates in Emei are the highest in China and the CDC attributes this to the influence of the peers, who care for around thirty to forty registered injecting drug users. They help them to adhere to treatment, and provide advice and guidance.

Drug users as peer educators

All the peer educators at Five Hearts are people who use or have used drugs. They are at the centre of the work, taking increasing responsibility for planning as well as implementing as their capacity grows. Ou Hongquan is the group’s leader and says, “We already have the right experience and background and we know what we want and need.”

One innovation is the development of a relatives committee. They consider it vital to involve drug users’ families and help them to understand drug use and support people on MMT.

Back at the teahouse, Cheng Ling finishes her work for the evening and is going home to her daughter. The project has provided her with stability, purpose and a safety net. “When I’m really down I can turn to people I trust. When we go and share our experience with other groups I feel like we are doing a really good job,” she says smiling.