PSI/Thailand 0

A qualitative and quantitative study on a peer-support program for IDUs

WORK MOTIVATION

OF PEER EDUCATORS

IN CHAMPION IDU PROJECT

PSI/Thailand 1

This research would not have been successfully implemented without the financial support from the Global Fund. The persons who contributed in the process of planning for this research and in the preparation of this report include Duangta Pawa (Researcher) and Yaowalak Jittakoat (Research and M&E Manager) with the support from Gary Mundy (Researcher, Southeast Asia) of PSI Foundation and Jessica Kraus (Intern). Qualitative data were collected and analyzed by Duangta Pawa, Yaowalak Jittakoat, and Punya Thongkui (MIS Officer). Quantitative data, on the other hand, were collected and analyzed by Sindh Ratchasi (Data Analyst).

Research and M&E Team, PSI (Thailand) Foundation, would like to extend our gratefulness to all the teams in the sites, namely Ozone drop-in center and Thai Drug Users Network, for the coordination and support for this study.

Duangta Pawa Researcher, PSI (Thailand) Foundation

Q. House Convent Bldg. Unit 12A, 38 Covent Road, Silom, Bangrak, Bangkok 10500 Tel: (662) 234-9225-9 Email: duangta@psithailand.org

Yaowalak Jittakoat

Manager, Research and M&E Section, PSI (Thailand) Foundation Q. House Convent Bldg. Unit 12A, 38 Covent Road, Silom, Bangrak, Bangkok 10500

Tel: (662) 234-9225-9 Email: yaowalak@psithailand.org

Gary Mundy Regional Researcher, PSI Southeast Asia

Tel: +84-4-944-6324 Email: gmundy@psi.org

ACKNOWLEDGEMENTS

The views described herein are the views of this institution, and do not represent the views or opinions of The Global Fund to Fight AIDS, Tuberculosis and Malaria, nor is there any approval or authorization of this material, express or implied, by The Global Fund to Fight AIDS, Tuberculosis and Malaria

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Page

Executive Summary 1

Background 2

Description of Intervention 2

Study Rationale 3

Concept and Theory 4

Research Objectives 6

Methodology 6

Findings 9

1. The initial turning point for becoming a peer educator 9

2. Expectation of a role as a peer educator 11

3. Overall work motivation 13

4. The happiness derived from work 14

4.1 A chance to help and give counseling to IDUs 14

4.2 A chance to develop oneself 17

4.3 A chance to reflect ones own problems 19

4.4 Behavioral change 20

4.5 Gaining acceptance 22

5. Work challenges 28

5.1 Challenges in doing the outreach work 28

5.2 Pressure from work and other pressures in life 30

5.3 Situation of personal drug use 32

5.4 Relationship with colleagues 34

5.5 Capacity building 36

5.6 Appropriateness of workplace and equipment 37

5.7 Remuneration 39

Implications for the Project 41

CONTENT

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Page

Annexes

Annex 1: DELTA Marketing Plan 43

Annex 2: Qualitative Data Analysis 44

Annex 3: Demographic data of peer educators in CHAMPION IDU Project 47

Annex 4: Table displaying the means of the scores given for the importance and satisfaction for each factor by peer educators

48

Annex 5: Graph displaying the scores given for the importance and satisfaction for each factor by peer educators of CHAMPION-IDU Project

50

Annex 6: Graph displaying the scores given for the importance and satisfaction for each factor by peer educators of Ozone House

51

Annex 7: Graph displaying the scores given for the importance and satisfaction for each factor by peer educators of Friendship House

52

Annex 8: Graph displaying the scores given for the importance and satisfaction for each factor by peer educators of TDN

53

PSI/Thailand 1

Peer education involves using members of a given group to affect change among other

members of the same group. Peer education is considered an effective intervention channel to

reach IDUs, a hard to reach most at risk population (MARP).

The CHAMPION project relies on skilled peer educators to achieve the ultimate program goal of

harm reduction. A strategic priority of this program is to train peer educators through capacity

building activities. This research aims to gain knowledge on peer educators who are enrolled in

the CHAMPION project: their lifestyles, the expectations, motivation and happiness that they

receive from their work, as well as the obstacles they encounter as peer educators. The input

from this research will aid in programmatic planning for PSI/Thailand.

This research was carried out in two phases: i) A qualitative study was conducted through in-

depth interviews in order to explore the lifestyle of peer educators, their challenges and

obstacles in life, feelings about working as a peer educator, happiness derived from work,

unfavorable aspects of their jobs, and an approach for work improvement ii) A quantitative study

was conducted using a questionnaire to collect data on 85 peer educators.

This research found that peer educators in the CHAMPION project are highly motivated to

achieve their work goal of supporting and improving the lives of IDUs. Working as a peer

educator had positively improved the lives of the interviewees. The peer educators also felt that

they have gained work experience from their job. However, interviewees stated difficulty

gaining acceptance from their family, peers, and community as peer educators. Moreover, the

study found that the work atmosphere of peer educators could be improved, including their

relationships with colleagues. Moreover, peer educators face various problems and obstacles

brought on by various activities and factors, including outreach work, personal drug use,

relationships with colleagues, work environment, capacity building, and remuneration. This can

lead to work and life pressure for peer educators.

PSI will develop a comprehensive strategy based on these results. The strategy will focus on

increasing acceptance for peer educators, especially from their families. Programs will be

strengthened by including regular reminders of the positive aspects of peer education, including

the impact the occupation has on themselves, their families, and community. This will

strengthen the value peer educators have for their work. Other areas of improvement include

improving capacity building to suit the personal needs of peer educators, creating healthy

relationships between peer educators and their colleagues in order to better the working

environment, minimizing interpersonal conflicts, emphasizing respect for the differing opinions of

coworkers, and reducing fieldwork obstacles.

EXECUTIVE SUMMARY

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HIV is mostly concentrated among Injecting Drug Users (IDUs) in Thailand. They are a hard-to-

reach group, often disconnected from existing health care services. The number of IDUs in

Thailand is estimated at 40,300.1 The surveillance data for HIV and STIs in relation to the risk

behaviors for HIV transmission among IDUs have shown that the HIV prevalence among IDUs

was equal to 21.9%.2 Various research studies indicate that needle sharing among IDUs is

common and low rates of consistent condom use.

In order to reach IDUs, the most at risk population and hard to reach group, peer education has

been considered to be the effective channel for the intervention. Peer education typically

involves the use of members of a given group to effect change among other members of the

same group. Peer education is often used to effect change at the individual level by attempting

to modify a persons knowledge, attitudes, beliefs, or behaviours. However, peer education may

also effect change at the group or societal level by modifying norms and stimulating collective

action that leads to changes in programmes and policies.34

Population Services International (PSI) is a non-profit, non-governmental organization (NGO)

specialized in social marketing of HIV prevention, family planning and maternal and child health

products and services.

PSI/Thailand has been operating in Thailand since 2002. PSI/Thailands programs use peer

education and drop-in centers (O-Zone) to promote safer injecting and sexual behavior among

IDUs. Additionally, programs use social marketing strategies to increase access to and

availability of needles, syringes, condoms, and VCT and STI testing for IDUs.

In 2008, PSI/Thailand was awarded Principle Recipient (PR) status for the IDU component of

the Global Fund Grant Round 8 HIV/AIDS entitled Comprehensive HIV Prevention among

MARPs by Promoting Integrated Outreach and Networking (CHAMPION). By 2010,

PSI/Thailand implemented a program designed to achieve significant and sustained behavior

1 Research Institute for Health Sciences, Chiang Mai University, 2011

2 Bureau of Epidemiology, MOPH, Thailand

3 Peer education and HIV/AIDS: Concepts, uses and challenges, UNAIDS, 2000

DESCRIPTION OF INTERVENTION

BACKGROUND

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change among IDUs in 15 target provinces. Specifically, at an impact level, the program aims to

increase the number of IDUs who report that they used sterile needles and equipment at the last

time of their injection and increase the number of IDUs who report that they used condom at the

time of their last sex act. At an activity level, programs are designed to i) provide information

about HIV, STIs and harm reduction ii) distribute injecting equipments and condoms through

drop in centers, peer educators and pharmacy ii) refer IDUs to VCT and STI testing and

treatment centers.

PSI/Thailand has operated five drop-in centers and outreach work in five provinces: Bangkok,

Nonthaburi, Chiang Mai, Chiang Rai, and Songkla. PSI/Thailand also cooperates with Sub-

Recipients (SR) and Sub-Sub Recipients (SSR) in the operation of 12 drop-in centers and

outreach work in 15 provinces throughout Thailand. As of September 2011, a total of 85 peer

educators have been recruited and trained in intervention strategies for each work area.

Peer educators are at the front line of the CHAMPION program. In order to achieve the

programs ultimate goal, effort of the back office must be put on peer educator capacity building

for peer educators. This capacity building is the strategic priority for Phase 1 of the program

(see DELTA Marketing Plan, Annex 1). The main objective of capacity building is to ensure that

peer educators enhance their skills and knowledge in order to help themselves and other IDUs.

High performance by peer educators is a key for program success. Performance is considered

to be a function of ability and motivation. Ability depends on education, experience and training

and its improvement is a slow and long process. On the other hand, motivation can be improved

quickly.45 Therefore, this study aims to identify and explore the motivation of peer educators in

the CHAMPION project. These findings will be used to provide programmatic recommendations,

ways to quickly increase the motivation of peer educators in order to improve the capability and

efficiency of these educators.

5 4 Motivation theorists and their theories, http://www.accel-team.com/motivation

STUDY RATIONAL

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In order to research the motivation of peer educators, PSI/Thailand based this study design on

Frederick Herzbergs Two Factor Theory, a widely accepted work motivation theory.56

Herzberg attempted to explain work motivation by identifying the factors that motivate

individuals to satisfy their needs, desires, and aims. The Theory is based upon the notion that

motivation can be split into hygiene and motivation factors, as shown in Figure 1.6

Figure 1: Motivation concept and theory of Frederick Herzberg

Motivation Factors: Motivation factors are intrinsic conditions of the job itself. These factors

bring positive job satisfaction, leading to higher job performance. Factors include:

- Achievement: This refers to a situation in which the individuals have been able to do their job completely and successfully, which demonstrates their abilities to solve and

prevent problems. Once success in their jobs has been achieved, they feel satisfied and

delighted.

6 5 Herzbergs Motivation-Hygiene Theory (Two Factor Theory), http://www.netmba.com/mgmt/ob/motivation/herzberg

6 Frederick Herzberg - Motivational Theory, http://www.envisionsoftware.com/articles/Herzberg_Motivational_Theory.html

CONCEPT AND THEORY

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- Recognition: This refers to when individuals gain recognition from their supervisors. Such recognition may be demonstrated (after the individuals have done a job

successfully) through a commendation, congratulatory statements, encouragement, or

any other actions that indicate an acceptance for the ability of such individuals.

Recognition normally exists as a part of the achievement.

- Intrinsic aspects of the job: This refers to job satisfaction that comes from a task that requires initiation and creativity and is challenging and interesting for the individual. Or it

may be a job that can be done successfully by only one person from the beginning to the

end.

- Responsibility: This refers to the satisfaction that individuals develop when they are assigned to take responsibility for a new job and are authorized to take the responsibility

independently, without close supervision or strict control.

- Promotion: This refers to the situation when an individual is promoted to a higher position within the organization; or offered an opportunity to further the individuals

studies or participate in trainings.

Hygiene Factors: Hygiene factors do not give positive job satisfaction, but are needed in order

to sustain work motivation at all times. The presence of hygiene factors for motivation is

especially important when motivation factors are not present, depleted, or not in line with those

of other people in the organization; which may cause individuals to dislike their jobs. These

factors are extrinsic, derived from somewhere outside the individuals and include:

- Salary: This refers to jobs that have a salary (remuneration) and criteria for giving a raise that is satisfactory for the individuals.

- Work environment: This refers to the physical environment of individuals workplaces, such as the illumination, sounds, ventilation, and any other things in the environment

that can affect an individuals job satisfaction, e.g. the equipment, instruments, etc. It

also refers to the length of working hours.

- Relationship with colleagues: This refers to the quality of interactions between individuals and their coworkers, including supervisors and subordinates. Factors include

physical and verbal communications, the nature of working together (whether it is

harmonious or not), and the understanding that coworkers have one another.

- Supervision: This refers to the ability of a supervisor to ensure good performance and justice in his conduct.

- Companys policy: This refers to the organizational management and administration, as well as the communication within the organization.

PSI/Thailand 6

Study findings are to be used in the development of a plan to increase the motivation of peer

educators in the CHAMPION project. The specific objectives of this study are as follows:

To understand the lifestyle of peer educators in CHAMPION Project, their expectations,

motivation and happiness that they receive from their work, as well as the obstacles they

encounter;

To identify work motivation and work challenges of peer educators and propose an

approach to improve work.

PSI/Thailand Foundation worked together with partner organizations in the CHAMPION project,

government sector, as well as academic persons to develop the methodology for this research.

This study on work motivation of peer educators in the CHAMPION project was conducted

during the period from November 2010 to July 2011. Data collection was carried out in 2

phases. This study consists of both qualitative and quantitative studies.

Study Population

The study population included all peer educators in the CHAMPION project from 12 drop-in

centers (as shown in Figure 2). As of July 2011, there were 85 peer educators enrolled in the

CHAMPION project.

RESEARCH OBJECTIVE

METHODOLOGY

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Figure 2: The number of peer educators in 12 drop-in centers of CHAMPION Project

Data Collection

Data collection for this study was carried out in 2 phases: qualitative data was collected in

Phase 1, quantitative data in Phase 2.

Figure 3: Data Collection Phases

Phase 1: Qualitative Data Collection - This phase was conducted using in-depth interviews in

order to explore the lifestyle of peer educators, their challenges and obstacles in life, how they

felt after working as a peer educator, happiness derived from work, unfavorable aspects of their

job, and an approach for work improvement. The interviews were conducted by PSI/Thailand

Northern Region

Central Region

Southern Region

PSI/Thailand Foundation

Ozone Fang (9)

Ozone Chiang Rai (8)

Ozone Prachachuen

(17)

Ozone Chana (7)

Raks Thai Foundation

Mitrapab On-nuch (3)

Mitrapab Pak Nam (3)

Mitrapab Surat Thani (6)

Mitrapab Nakhon Sri Thammarat

(4)

TDN

TDN Chiang Mai (13)

TDN Trang (5)

Alden's House

Alden's House (3)

TTAG

Mitsampan (7)

Phase 1: Qualitative Research

Qualitative data were collected to explore: expectations, job satisfaction, attitudes towards job, as well as problems, obstacles and challenges from working in the CHAMPION project.

Phase 2: Quantitative Research

Quantitative data were collected to explore the importance of each motivation factor and overall work motivation among all peer educators in the CHAMPION project.

PSI/Thailand 8

Foundation researchers. The interviews were carried out following an interview script. 12 peer educators were interviewed in total; of those, 3 were working in the North, 3 in the South, and 6

in the Central Region. The research team received consent from the participants before

conducting interviews. The data obtained through this collection process were analyzed

collectively as a whole without specifying any personal identifiable information. The data

collection was carried out from November to December 2010.

Phase 2: Quantitative Data Collection - The questionnaire used for collecting these data was

developed based on analysis of results from Phase 1. Based off of the motivation theory, the

questionnaire was divided into motivation factors and hygiene factors. Under each section,

there were 5 sub-topics. The items in the questionnaire were grouped into 3 parts. Part 1

included items on general job expectations. The informants would give a score for the

importance that each factor has on job motivation. Part 2 addressed opinions about their work

as a peer educator, which would reflect their job satisfaction or work motivation. Part 3 involved

the demographic data of the participants. To collect the data, the questionnaire and relevant

explanations were sent to the managers of the 12 drop-in centers, who would distribute them to

the peer educators in their center and send them back to the researchers upon completion.

Names and other personal identifiable information were not recorded on the questionnaire.

Quantitative data collection was carried out from July to August 2011.

Data Analysis

Data analysis was carried out separately by phase.

Phase 1: Qualitative Data Analysis - Interviews were transcribed from tape recordings,

compiled and presented as a dialogue. Archetype information (i.e. data on different

characteristics of peer educators) was identified and used as input for designing the motivation

enhancement process for the peer educators in the CHAMPION project (as shown in Annex 2).

Phase 2: Quantitative Data Analysis Questionnaire data were analyzed using Excel and

SPSS. Due to a small sample size, analysis on motivation and hygiene factors is presented in

means. Analysis involved comparing motivation and importance scores for each factor among

all peer educators in the CHAMPION project. (Annex 3-8)

PSI/Thailand 9

1. The initial turning point for becoming a peer educator

Peer educators switched jobs in order to start working as a peer educator for the CHAMPION

project. Based on the data collected, previous jobs of peer educators were not regular and were

meant to serve as a temporary way to earn money.

Before working here, I was a coolie; a general coolie! It was a job where each coolie would do

separately and on their own. But in doing this voluntary job, its like we are part of the same

family, despite the fact that we all have come from different places.

(PE 1, Male)

Before becoming a peer educator, I was a tattoo artist. I was busy with that work every day,

with a lot of customers. The income was okay, a little bit over ten thousand Baht; but everyday

life was always the same. By doing this voluntary work, I had the chance to make friends.

Compared to my previous job, this work makes me happier. It allows me to have more friends

from various places. The income is about the same but I feel happier with this work. It gives me

a chance to meet friends and give them information.

(PE 7, Male)

Before becoming a peer educator, I was a layman for some construction workers. I sometimes

took a job carrying pieces of wood, firewood, or lumber (the ones they cut in the mountains, and

taking down to houses). I took one assignment at a time and got paid day by day.

(PE 10, Male)

Peer educators who reported that they sometimes had problems at their previous workplace

had to stop working after coworkers found out that they were a drug user.

Before working here, I made some furniture on a contractual basis. But when they knew that I

used drugs, they boycotted me. I used to have a house and some other properties, but I had to

sell them all. You see I had to leave the job that I could do better than a non-drug user.

(PE 5, Male)

Peer educators became peer educators after persuasion from staff or current peer educators,

ones whom they knew from a methadone clinic. Current peer educators recruited by describing

the nature of their job, the works, sharing information about outreach work, as well as the

benefits they would get from working as a peer educator.

FINDINGS

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As far as I can recall, they [current peer educators] told me that I would get a given amount of

money from doing it [peer education]; that I would have a chance to help friends by preventing

them from using or sharing a used needle and that I could go out and teach this to all of these

friends, also that I would be sent to attend training frequently. I felt good about that and I was

able to gain more knowledge.

(PE 8, Male)

I have been a peer educator for 5-6 years. A younger friend in a drug-user group persuaded

me to do this. He told me that there had been a project of this kind. So, I started to learn about

it. At that time, I had been associated with a drug user group and other members of my family

also used drugs, and some of them became infected (with HIV). So, I did have a considerable

amount of knowledge before joining this program. I just came to take a look at the Center first

and did not apply for the position right away. What happened was my elder friend became a

member first and he persuaded me to do the same. It was not until 1-2 months later that I

started serving as a peer educator in the first batch of the peer educators for this place.

(PE 7, Male)

A peer educator from this place advised me to come here to take methadone. And after I

started my enrollment in the methadone program, he persuaded me to come to the Center. I

came here every day. And I saw the job announcement for the position of a peer educator; so I

applied for the position, because I wanted to be a peer educator the same as other people.

(PE 10, Male)

Before working for the CHAMPION project, some peer educators were not confident about their

abilities and were concerned because they were still using drugs. Meanwhile, some other peer

educators realized that it was important to have someone who are directly involved in the issue

serve as the person to give information to peers in the same group. They thought that this way

would be a better way towards success.

Initially, I did not think about taking this job; because, as a drug user, I always was a hot-

tempered person. My friend, who had already been a peer educator, explained to me briefly

about what a peer educator does. He told that drug users were always sensitive to emotion. If

drug users talked to each other while they were both in a hot temper, they would never be able

to talk peacefully but tended to fight. So, I thought, as I always was impetuous, that it would not

be suitable for me to apply for the job. But, after a second thought, I realized would never know

unless I tried to do it first. So, I decided to apply for this position.

(PE 1, Male)

One of my elder friends told me that there would be an establishment of a harm reduction

program and asked me whether I would be interested in a job with this program. Initially I was

afraid that I would not be able to do this job. So, he advised me to just give a try. If I could not

do it, then it would be fine. But if I could do it well, then I could continue. And once I started

doing this job, I liked it. I had a chance to help friends and a chance to take care of myself. I was

not healthy at that time. Before doing this work, I just enjoyed life without taking good care of

PSI/Thailand 11

myself. But after I started working here, I have been able to take care of myself and help my

community at the same time.

(PE12, Male)

At the beginning I wondered if it [peer education] would work, wondered how to do it, and

wondered if it would be done successfully. But after giving a try, I thought it really worked.

Because it was easier for the friends to talk to us instead of talking to a staff member who had

no experience in using drugs at all. It would be easier for us to approach them. We and our

friends could understand each other well because we used the same language.

(PE 3, Male)

This study found that prior work experience varied from one peer educator to another. As a

result, their perceptions and expectations also varied. Several educators intended to do this job

because it would allow them to help other people. Meanwhile, some of these peer educators

were fired from their previous jobs due to their drug use, which might have made them feel like

they did not have many job options So, at the beginning, they did not feel confident doing their

job because of their current drug use, emotional status, and experience (i.e. they thought they

did not have appropriate knowledge and ability to work as a peer educator).

2. Expectation from working as a peer educator

All peer educators in the CHAMPION project shared the same job expectations: that they would

be able to help other people and develop or improve themselves.

Helping other people was the expectation that the peer educators wanted to achieve. They

wished to serve as a person whom their peers/friends could rely on for physical and

psychological support and for safe help (e.g. as a starting point to quit, they could take their

peers for methadone treatment).

I intend to help peers in almost all aspects of their lives. I can serve as their parent, sibling, or

friend. At times when they need assistance, need warmth, or need somebody whom they can

rely on physically and psychologically, I can be just like one of their siblings.

(PE 10, Male)

I really want to help them [injecting drug-users]. Though they do not want to quit, I just want

them to inject safely and have a lower chance of infection. I do so by always telling them [drug-

users] to use it [needles] only once and then put it away. I want to see them quit, see them have

a job. I have explained to them that if they quit [injecting] and switch to using methadone, the

drug will last 24 hours, and they can work normally. Just take a bottle of it [methadone] after

waking up in the morning and you will feel fine for 24 hours; you will be able to work normally

from the morning until the evening.

(PE 8, Male)

PSI/Thailand 12

Some peer educators highlighted that they expect to develop or improve themselves by being a

peer educator. They thought that, by doing this work, they would be able to enhance their

capability. For example, their knowledge, ability, and life skills would increase. They also wanted

to develop their capability for serving as a facilitator.

(I want to be) capable of doing everything, including organizing a variety of activities and giving

talks on topics related to us, such as AIDS.

(PE 11, Male)

After working as a peer educator, my life has been improved up to a certain level. I do not have

to sell drugs like before. I never did any work in life apart from selling drugs, being put in jail,

and going out to sell drugs again. It happened like this all along. Now, working as a peer

educator is better than selling drugs. There is no worry about being put in jail. Also, this job

allows me to have more knowledge and gain skills for spending my life outside [of jail]. I had

very minimal skills of this kind really, because I spent most of my time in jail. I have learned and

gained these skills gradually.

(PE 6, Male)

Doing this job has already been the best for me. I have learned a lot of things, met a lot of

people, and gained experiences. I think I would love to be a facilitator to disseminate information

to the community. A lot of people still do not know about this. They still think that AIDS cannot

be treated, but indeed it can be treated.

(PE 12, Male)

I want to be a very capable facilitator, the most capable that I can be. So far I have not been

capable of much but good enough to serve as a facilitator for many schools already. However, it

seemed that I could not do it as perfectly as I wanted to. I really want to be a perfect one.

Sometimes I went to a school and the students raised some questions that made me feel so

stunned and I feared that I would answer them incorrectly.

(PE 9, Female)

Understanding the expectations that peer educators have is important for PSI/Thailand. Peer

educators still working for the CHAMPION project can be reminded of these expectations. This

can create work motivation and enhance their performance.

Graph 1 displays the results of the Phase 2 quantitative survey. The graph explores overall

motivation by exploring the importance and satisfaction that the 85 peer educators in the

CHAMPION project have for Kerzbergs various motivation and hygiene factors. Importance

can be referred to as the expectation for each topic or issue. The results of the analysis by

topic are described below.

PSI/Thailand 13

3. Overall work motivation

Among all 85 peer educators of the CHAMPION project, work satisfaction scores were

calculated at 71%. Mean importance and satisfaction scores were calculated for each

motivation factors. Mean scores were similar with no more than a 0.2 difference between

importance and satisfaction ratings.

On average, peer educators considered all factors important; no importance value was less

than 4.0. The highest rated motivation factors were: responsibility (mean = 4.7), achievement

(mean=4.4), and intrinsic aspects of the job (mean=4.4). The highest rated hygiene factor was

supervision (mean=4.4).

The lowest rated motivation factor was recognition (mean=4.1); the lowest rated hygiene factor

was salary (mean=3.9).

Graph 1: Means of the scores for importance and satisfaction given by 85 peer

educators of CHAMPION Project

Responsibility

Achievement

Intrinsic aspects of the job

Supervision

Work environment

Relationship with colleagues

Promotion

Company policy

Recognition

Salary

Importance Satisfaction

PSI/Thailand 14

4. Happiness derived from work

Peer educators in the CHAMPION project received happiness from their work for various

reasons. Peer educators reported feeling happy from i) having a chance to help and give

counseling to IDUs; ii) personal development; iii) reflect on ones own problems; iv) injecting

drug use behavior change; v) gaining acceptance for themselves and others.

4.1 A chance to help and give counseling to IDUs

Peer educators spoke of being happy that they had chance to help and give counseling to

peers. They emphasized that they assisted in sharing knowledge that would lead to a behavioral

change: knowledge about their rights and the distribution of needles and equipment to peers.

They also were satisfied by making an effort to reach peers who had not disclosed themselves

yet.

I will give a priority to friends, the ones who have not disclosed themselves yet. This group has

not had any knowledge to use as a shield of protection. If we can reach this group, its our

success. A lot of friends got infected and die because most of them do not have a set of

information that could help protect them. If we meet them and give them a shield, give the

preventive information to them, they will be able to apply it and that will be good for them. If we

can this, it means that we have achieved success.

(PE 3, Female)

I love the time when I reach out and meet with friends; because, there are a lot of friends in

community, and I can provide them with information. They would then know about their rights

that they are entitled to. In the past, they did not know about their rights and eligibilities at all.

They never received the equipment (through distribution). Whenever they wanted to use drugs,

they had to buy needles and equipment and use them repeatedly 4-5 times. Now, new needles

and equipment are always available for them to use. In the past, they used the water that had

been left in a glass for a number of days as the solvent for the drugs.

(PE 7, Male)

The work as a peer educator can help friends gain knowledge, know how to use the needles

correctly, and avoid needle sharing. Sometime they come to ask for needles from me. So, I

have to take some needles and make them available at my house too.

(PE 10, Male)

This work gives me a chance to go out and meet friends in the community and advise them

about harm reduction programs. In the past, there was not a project of this kind and no

distribution of clean equipment like this. Thats why a lot of friends had passed away. If Ozone

house was established sooner, the situation at that time might have been better. Though these

friends might have realized that their time had come for them to pass away, I think this program

might have been able to help them somehow and they would not have lost their lives. They

might not have shared a needle and might have developed a higher level of awareness.

PSI/Thailand 15

I have been able to help our members. There is one point that I really like. That is when I go out

and help some people whom I am not acquainted to, they will reflect and let me know something

about how I think about them and how they think about me. They might not say a word to

claim that nobody else ever paid attention to them and that they felt good about us. We helped

them improve their health, accompanied them to the hospital, so they felt good about this.

(PE 12, Male)

What I love doing the most is going out and providing knowledge to a group of friends. This

way, I can talk to several people at a time, and they can give feedback and ask questions. Then

I can give answers with necessary information. And we also dine together. I want them to

develop awareness about the drug use and HIV issue, to use a needle only once, and discard

their used needles properly in a box prepared specifically for this. And they should not take

them for re-use. I feel good that I can help friends. It takes a long time before the friends and I

can understand each other. Today I do everything for friends, for my family, and for all drug

users, wanting them to become aware that they need to take care of their health. Once they

have suffered from drug use they must maintain good health and must know to use injecting

equipment only once before discarding it.

(PE 5, Male)

In addition, peer educators discussed gaining happiness from providing assistance and

counseling to peers. Specifically, they spoke of the happiness they gain from seeing their peers

become healthier and more motivated, have a better quality of life, develop awareness, and

change their health behaviors, including minimizing their drug use. Motivating peers is a

particularly important item, especially for currently injecting IDUs.

I had a chance to help members and to engage myself with friends. For example, I had a

chance to visit and motivate them and to see them become healthier and minimize their drug

use. The members told me that their lives improved by 70-80%. This already made me feel

happy. In the past, they [IDUs] would resist us. Now, they have accepted us more and

responded to us better than in the past. Now, they are happy to talk to us. We have been able to

develop a close relationship with members because we work heart-to-heart.

(PE1, Male)

I would rather say that happiness is developed inside my mind, happiness from having a

chance to help friends, to see friends improve their quality of life. Its the happiness from doing

this, from doing this work.

It could be described this way. I can listen to them and they can express their feelings. They can

release stories to an outsider, to a person who is listening to what they are saying. These

stories may be regarded by other people as being nonsense. Other people may decline to

listen. But we can listen to them. They have uncomfortably kept these issues inside their mind

for a long time. And when they have a chance to speak up, they express them all. ... I motivated

them and they were able to express their stories to me for me to listen. I am happy to see them

PSI/Thailand 16

express something that they cannot reveal to anybody else. It means that they have trusted

me.

(PE 4, Female)

I do some of my work for other people, for community. I do this work because their situations

are really, really bad! Its about paying a visit to the members who are sick. It reminds me about

the time when I was sick and somebody visited me. Though he could not help me much, I felt so

good that he came and asked whether there was anything he could help with. However, the

main point was about the encouragement received by me.

(PE 10, Male)

The motivation factor regarding responsibility gained the highest level of satisfaction. This factor

included the aspect of feeling good when helping others (mean = 4.7) and being a peer

educator is to help others (means = 4.7). Mean satisfaction scores were slightly higher than

mean importance scores. (Graph 2)

Similarly, all factors involving intrinsic aspects of the job (peer educator is a fun and challenging

job, I feel good when visiting and providing knowledge to my friends, and I feel good when I

can be my friends consultant) were all highly rated (mean=4.4). Mean satisfaction scores were

rated slightly higher than importance scores. (Graph 3)

Graph 2: The importance and satisfaction values given by 85 peer educators in CHAMPION project to the motivation factors regarding responsibility

Feeling good when helping others

Being a peer educator is to help others

Importance Satisfaction

PSI/Thailand 17

Graph 3: The importance and satisfaction given by 85 peer educators in

CHAMPION project to the motivation factors regarding intrinsic aspects of the job

Peer educator is a fun and challenging job

I feel good when visiting and providing

knowledge to my friends

I feel good when I can be my friends consultant

Importance Satisfaction

High mean values for motivation factors related to responsibility reflect satisfaction peer

educators receive from being assigned a job. Additionally, high mean values related to intrinsic

aspects of the job reflect peer educators interest in their job. That is, that creativity and initiation

were required to do such a job. These highly scored factors can be used to enhance the work

motivation of peer educators.

4.2 A chance for personal development

Peer educators in the CHAMPION project felt that they had a chance to personally develop by

being a peer educator. Apart from using acquired knowledge to provide information and

counseling to their peers who inject drugs, peer educators also felt that they had gained more

knowledge and had a chance to learn how to properly manage finances.

After a center of this kind started its operation, I have gained more knowledge. I did not know

much before this. What I had heard was about HBV [Hepatitis B] only; and now I know about

HCV [Hepatitis C], know how it can get transmitted and so on. They provide me with the body of

knowledge. For example, in the past, I had no idea about what to do when my friend was

suffering an overdose.

(PE 7, Male)

I had a chance to learn how to maintain a good health, how to properly manage my personal

drug use. Through this, I have been able to initiate a change in my life better than before.

(PE 12, Male)

PSI/Thailand 18

I was really a big spender in the past. After working in this job, I now know how to manage my

spending. As my income was decreased, I had to economize everything, reducing my drug use

and reducing the spending of my wife and my kids. My wife wanted me to stop doing this job,

but I think there are a lot of drug users (waiting for me to go out and help them).

(PE 10, Male)

Working as a peer educator has offered IDUs a chance for personal development, which is an

indirect outcome of the project. Through this work, their knowledge and skills for giving

information and counseling to others has been enhanced.

Furthermore, peer educators discussed the experiences they receive from various peer

educator training sessions that allow them to meet people whom they had not known before and

visit a place they had never been to. They also mentioned happiness derived at work, including

feelings of happiness from having a chance to personally develop, increase their life experience,

and manage their life better.

I had a chance to gain knowledge, receive training, broaden my vision, know a lot of people,

visit a number of places, meet people whom I had not known before, and exchange knowledge

with others. Given that I have a poor educational background, the ideas I got from all of these

activities have been useful and can be applied to my work.

(PE 11, Male)

By undergoing training with other organizations, I had a chance to meet friends from different

organizations, exchange information with them, and learn many things from them and their

experiences.

(PE 4, Female)

Actually, I was not an outgoing person, did not dare to lead other persons. And there were so

many other things I never thought I would have a change to get exposed to. But after engaging

in this work, I changed a lot. I had a chance to attend a number of trainings in other provinces.

Normally, it was very rare for the drug users to have such an opportunity, given that they were

addicted to drugs and could not go anywhere very far from their regular places. But I had a

chance to go and to stay in a nice hotel. That was a rewarding experience in life. If I did not

engage myself in this job, I would never have experienced this and never have gone through a

number of training. I initiated a lot of changes in myself. I know how to behave myself in society;

I know to not behave wildly as before and know how to speak more nicely. My life has changed

for the better. I receive a salary and have a chance to go sightseeing during the training. When

other organizations organized training in other provinces, people would talk about the places

they had a chance to visit during the training. And that made me want to go to the training, too.

This kind of thing may be considered as very ordinary for others. But for us, this is a very

luxurious and pleasurable activity.

(PE 2, Male)

PSI/Thailand 19

During my previous employment, I just did my work without letting them know that I used drugs.

They treated me the same way as they would for a normal [non-IDU] person. But, actually, I was

not normal. If they knew that I used drugs, my only option was to get fired. But for this voluntary

job, they understand drug users. Additionally, they understand the problems that a person who

uses drugs faces, so they provided counseling and gave a chance for us to talk. For

employment in another job position, such as an employee, a company worker, or a receptionist,

I sometimes went to work late due to my drug use or I had to sneak out of the office quite often.

But for this work, after I told them about my drug use, they advised me and offered a number of

options for me to choose from in order to manage my personal drug use. So, I have a guide to

follow.

(PE 3, Female)

By working as a peer educator in the CHAMPION project, interviewees got more than just a

chance to learn how to do this kind of job. This job also has an impact on the peer educators in

terms of learning new knowledge and skills, gaining opportunities to attend trainings, meet

peers from other organizations, and travel to many different places. Knowing that it is very rare

for these drug users to have a chance to travel, getting involved in these activities is considered

a good chance for peer educators. Additionally, employment as a peer educator in the

CHAMPION project also gives these educators an opportunity to work in an organization that

understands the lifestyle of drug users.

4.3 A chance to reflect on ones own problems

Interviewees discussed the opportunity that they have as peer educators to reflect on their own

problems. By going into the field and listening to the problems of others who have a similar

lifestyle, peer educators were reflecting on the problems that they had when they too had the

same pressure in life from drug use. After meeting with and talking to these peers, they reported

feeling more relaxed and coming up with ideas on how to improve oneself in order to support

others.

I feel happy when I work in the field, because I can make friends. Sometimes I feel quite

stressed at home. But I feel more comfortable when I meet with friends, do a group session

together, or consult each other. Sometimes we even sit on the floor while doing this. Sometimes

I go to a chicken-fighting arena to find a member. I have various successes finding a member

here. And if I can even find a member that would be good already.

(PEM 1, Male)

Sometimes when I feel stressed about my life, I go out and discuss with people about work and

some other things. I keep discussing until I forgot about the stress in my life. I provide

knowledge to friends. I want them to develop awareness and to use drugs safely.

(PE 10, Male)

PSI/Thailand 20

When I went to see old cases of my outreach work, to follow up on whether their situation has

improved and whether they are facing any problems, I had to put my very own problems aside. I

had to concentrate on these friends, trying to help them find a solution. And once I was able to

help them solve their problems successfully, it motivated me. I knew that I would be able to

mitigate my problems somehow. I think that working as a peer educator has ensured my

personal development up to a certain level. In the past, I did nothing but consumed drugs. Now,

I have a job which allows me to get exposed to my friends problems and that stimulates me to

take a look at myself and develop my energy for doing the job. This energy may not be of a

large scale but it has a very important impact. Suppose that I can stand with both of my legs one

day, then in the next step this will be a good backup for me.

Working as a peer educator helps me to explore myself better and be able to evaluate myself

well. For example, if I see a friend using drugs extensively, I already know what negative

consequences will follow. I can tell that because I have learned from the experiences I have

acquired from this job. I have learned about the problems and used that as a reminder to warn

myself, and at the same time, for giving me a push (for reducing my drug use). Because, if I still

use drugs extensively, what will happen to me will actually be the same as what happened to

my friends. If I look at (the life of) my friends well, it can reflect something about myself, too. If I

do not improve my practices that I have realized by seeing a friend doing the same practices,; I

will be the same as my friends.

(PE 3, Female)

Some peer educators also mentioned that seeing the life of the peers whom they went out to

work with (both the ones who had and had not changed their injecting behavior), allowed them

to reflect on their own current behaviors, and be able to foresee possible consequences. By doing this, their job allowed them to think about their own behaviors and create plans for improving their friends health.

4.4 Injecting Drug Use Behavior Change

By having a job that allows IDUs to personally develop, gain knowledge, reflect on their own

problems, and concentrate, some peer educators reported that they have changed their own

drug use behaviors by working.

As long as I am still doing this job, my personal drug use will be the same as what it is now.

Anyway, it wont get worse than this. And as I work on drug issues, it is for sure that I will also

use drugs. Things have been better regarding my family. Now, everyone in my family has

started to accept and understand the role of a peer educator. They really were against this job in

the past. After working as a peer educator, my drugs use has reduced because I have a job to

do and take care of. I have to spend my time paying attention to friends instead of using my time

for my own drug use.

(PE 5, Male)

PSI/Thailand 21

If I stayed home and was able to get some money in the morning, I would then go for drugs at

around noon. And if I was able to get money at around noon, then I would go for drugs in the

afternoon. I consumed drugs 3 to 4 times a day because I had a lot of free time, and also due to

several other factors. The community where I lived was not good. Drug sellers were plenty. The

head of the village was also involved in the deal. The drugs were plenty and I happened to live

in such a place. Sometimes when I did not have any money on me and was just sitting down

relaxing myself, I couldnt help but crave drugs because people were buying, selling, and using

drugs right before my eyes. But after I engaging in this work, I was enjoying my work so much

that I forget about the craving. Well, because, the work regulation does not allow any drug use

during the working hours. And as I have to suppress my craving during the working hours, it has

become my habit. I did not have much knowledge at the first place but I gained it more and

more over time. I then started to change my behavior. I use fewer amounts of drugs and use

them less frequently.

(PE 10, Male)

I love this job because I was once an addict. However, I was able to successfully quit on a later

date. I stopped using drugs and have taken methadone instead. You can use me as an

example. I dont need to use drugs. After waking up in the morning, I just take methadone and I

can go to work normally. Then I come home to live happily with my family; no need to struggle

for drugs at all.

(PE 8, Male)

Working as a peer educator is not a reason (a cause) for relapse. It really depends on the

individual.

(PE 7, Male)

I have been able to listen more openly to the reasons given by people around me. After

working as a peer educator, I have changed my behavior. I tend to do things in a less violent

way, become less irritable, and know how to control my emotions. Normally drug users cannot

control their emotions. But I have learned how to stay cool while interacting with people outside

of the drug circle, I mean the persons who do not use drugs. For example, I was able to stay

cool and listen to my wife when she scolded me. (I also changed) my habit, my spending, and

the way I talk; because, in the past, I normally talked with some bad and strong words. I gained

knowledge from the presentation given to me by my friends in the training. I had a chance to

take part in a number of activities. Normally, the addicts do not have a reason for whatever they

want, they would go for it at no cost. But when I live with other people, its impossible for me to

get whatever I want, so I have to change my drug habits accordingly.

(PE 10, Male)

Peers educators mentioned that they had changed their behaviors considerably while working

for the CHAMPION project. For example, peer educators said that they had acquired more

knowledge about health, earned how to better control their emotions, how to adjust themselves

so that they could associate with peers, and how to reduce their drug use.

PSI/Thailand 22

With respect to promotion as a motivation factor, Phase 2 of this study found that the highest

average level of importance (mean=4.7) and satisfaction (mean=4.8) given by peer educators to

a promotion aspect was to being a peer educator can make me have a more knowledge and

experience. Other promotion-related aspects received lower average satisfaction scores; these

aspects were that peer educator is a job that has opportunities for advancement (mean = 3.8)

and since I have worked as a peer educator, I feel that I have a better life (mean = 4.0). Levels

of importance were slightly higher than levels of satisfaction.

Results from this survey on promotion can be used as input for the development of an

intervention guide. This guide would ensure career advancement for peer educators, such as for

the training to enhance their knowledge, capacity, and life skills, as well as other aspects of life

quality.

Graph 4: The importance and satisfaction given by 85 peer educators in the

CHAMPION project to motivation factors regarding promotion

Peer educator is a job that has opportunities

for advancement

Being a peer educator can make me have more chance in life

Since I have worked as a peer educator, I feel that I have a better life

Being a peer educator can make me have

more knowledge and experience

Being a peer educator can make me manage my personal drug use

Importance Satisfaction

4.5 Gaining Acceptance from Themselves and Others

Gaining acceptance is a very important issue for IDUs. Due to their current lifestyles, peer

educators face stigmatization from people all around, and some of them have to hide

themselves from others. This has put peer educators under pressure and has made it more

difficult for them to access services. Peer educators in CHAMPION mentioned that working as a

peer educator has made them gain a higher level of acceptance from other IDUs, their family,

and the community in which they reside. By gaining such acceptance, they have developed

pride for themselves.

PSI/Thailand 23

Several peer educators felt good after they gained acceptance and trustworthiness from their

IDU friends. They gained this good feeling because they had received training sufficiently

enough to provide health information and give counseling to friends effectively and in a way that

friends would believe and trust. Ultimately, this training led peer educators to be seen as

dependable to their IDU friends.

I feel so good to work as a peer educator and to give information to members. I feel so glad

that I have a chance to do so. If I was not a peer educator, I would never be able to share this

information. But after I have been a peer educator, I believe people believe me more when I

speak.

(PE 10, Male)

I feel that some of my friends have accepted me more. I feel this through the way that they act.

For example, they agreed to go for a blood test after I asked. Normally, when they were alone

and on their own, they never thought about going. So, after I persuaded friends to join activities

and they agreed, it means that they trusted me. So, I feel proud that I have been able to help

them.

(PE 7, Male)

I am proud to gain acceptance from others, to provide knowledge and to take care of them at

the same time. Talking about friends, theres no need to talk about my close friends because

they always feel good towards me. But for those whom I had not been acquainted with, when

they realized that I had done this job in order to help them, they felt good. They said that before

this nobody had ever paid attention to them like I did. One time, there was a case of an IDU who

had been abandoned by his family and was suffering from an illness. When I reached him and

took care of him, he couldnt help but cry. He felt really touched because I was not his relative,

only an acquaintance, but I had helped him up to a considerable level. He felt very good. He

seemed to have been infected (by HIV), developed some opportunistic infections, and then

became sick. After that, I visited him at home. I assessed his condition and found that it was

very serious. I offered to take him to see the doctor but he declined to do so. He feared. So I

told him straightforwardly that if he continued to stay home like that, he would surely die. But if

he would go to see the doctor, the doctor might be able to help him. Today, he has been taking

antiretroviral, and his health has improved.

(PE 12, Male)

I have served as a consultant for my friends and a dependable person for them. I have also

associated with colleagues who also work as peer educators and that has made me gain

recognition and respect from society. When my friends come to me some questions, they

always show a certain level of respect and acceptance towards me, so it makes me proud of

myself. My friends did not accept me at the beginning because I also was a drug user, the same

as they were. But after I had gained knowledge from training, they started to accept me more

and more. I dont like Saturday and Sunday because they are holidays and I dont have to go to

work. I really dont want to stay alone. I would start to get bored in the morning and have to think

of a place to go and a thing to do. I dont have to think about these during the weekdays;

PSI/Thailand 24

because, I would go to work and meet friends, both the ones who work as a peer educator and

those who are the clients who come for the services.

(PE 2, Male)

Several peer educators also said that after they started doing this job, their families started to

accept them more. Their families realized the importance of peer educators. They knew that it

was a job for helping society and for ensuring the personal development of the educators.

My mother said that it was good for me to do this job because I would be able to take care of

myself and to help society at the same time. My parents are quite aged. I dont want them to

worry. I want them to feel happy.

(PE 12, Male)

My wife is happy that I have served as a peer educator. There are drug users who live in the

neighborhood where my house is located. Some of them did not have access to equipment and

they have not disclosed themselves yet. They do not want anybody, even their families, to know

about their drug use. Now, they can have access to equipment because they know that I am

doing this job to serve them. They come to me and ask for condoms and equipment.

(PE 7, Male)

My family wants people to know that I have a job that I can take responsibility for. They really

want me to have good things in life, be able to live harmoniously in the same society as other

people, without being isolated as a group of drug users or that of the HIV positive population. I

always feel happy whenever I can help drug users to get into the system and become self-

reliant, as if I can help save their lives

(PE 5, Male)

Because I have been able to do this job, they already view that I am an outstanding person, a

better person. They look at me with admiration and appreciation in their eyes. Every day when I

come home, they still keep looking at me in the same way; and it makes me feel confident.

(PE 1, Male)

Peer educators also shared that by working as a peer educator, their surrounding communities

had accepted them more. This acceptance was due to the peer educators changed behaviors

and the results that their work had yielded.

The surrounding communities started to look at me in a positive way, because I was

employed. Sometimes my friends spoke gladly about this. In the beginning, when I was new to

outreach work, it was hard for me to enter my friends houses. But later on, after I had worked

for a while, they started to accept me and allowed me to enter their houses. However, their

parents still looked at me in a negative way. Thats all right. I will keep visiting them in the future.

For my family, they said its good for me to do this. My wifes family also knows that I am a peer

educator and they are positive about me. They had kept watching me before this and always

PSI/Thailand 25

asked to find out where I worked. Now, my wifes family knows about this. my wife said that her

family looked at me more positively.

(PE 8, Male)

This has proved that peoples contempt towards drug users was wrong. Some people had

viewed that drug users would never be able to do anything and would be a burden to society.

That they would not be able to do anything but use drugs for the rest of their life. Whenever

something disappeared from peoples house, they would accuse drug users of stealing it before

thinking of any other groups.

(PE 11, Male)

Some people came to me saying that their children had become addicts and asked whether I

could help them with this. They said that I did not have to do something for their children to stop

using drugs but perhaps I could do something in a way that their children would be able to use

drugs safely, and be able to reduce their drug use. They came to ask for my opinion. And when

I wore this T-shirt, people always asked how this idea was initiated, I cannot stop using drugs

at the moment but I can work. And they asked further about where I got this T-shirt from. I told

them that I got it from my workplace. Then they would view me in another aspect. I did not

expect that they would have to change their thoughts. But when they actually changed their

thoughts, they would disseminate such a change to other people through their words of mouth,

and then the overall perspectives about this issue would be better.

(PE 3, Female)

For people around me, I think they have looked at me in a more positive way. In the past, they

regarded me as a drug user and declined to accept me. But after they knew that I have been

doing this job, and after they have noticed the changes I have made, now they act differently. In

the past, they might not speak a word but I could tell from their facial expression. What they had

in their mind might be, Here you come again and you will ask me to go for drugs together. But

after I have been doing this work and have known a lot of people, they learned that I have do

such work and they now look at me in a different way.

(PE 12, Male)

Some peer educators said that they felt good to have a job because it made the people around

them feel more positive about themselves. This made them feel proud about themselves, given

that they were drug users, but now had a sufficient level of capability to perform this work.

It makes me feel good. When I go to work in the morning and people ask, Are you going to

work? It makes me feel proud to feel l that I have a good image. They may not know what kind

of the work I do, but at least they know that I now have a job. This is different from the past. In

the past, people would not ask anything and would feel reluctant to talk to me. People who have

a regular job may not notice the change in this kind of greeting. But, for us, it is really good and

we are proud of it.

(PE 2, Male)

PSI/Thailand 26

Before taking this job, I felt that I was very useless. But after I worked, I felt that I had been

honored and gained a level of prestige. I am no longer afraid to walk into places.

(PE 9, Female)

In this qualitative research it is clear that peer educators value gaining acceptance from others.

Specifically, after they engaged in working as a peer educator, they received a higher level of

admiration, gained acceptance from their friends who injected drugs, their families, and

communities. Most importantly, they took the pride for themselves, for their ability to perform

their job.

Data on the importance of recognition from others for motivating peer educators were also

analyzed in the Phase 2 quantitative research of the entire CHAMPION project. Graph 5

displays the results of this analysis. Family-specific aspects were rated especially high. This

includes support from family for working as a peer educator (mean importance=4.3, mean

satisfaction=3.8) and family knows that I am working as a peer educator (mean

importance=4.4, satisfaction=4.1). Satisfaction scores for these family-specific recognition

aspects were lower than the perceived importance scores.

Graph 5: The importance and satisfaction given by 85 peer educators in

CHAMPION project to the motivation factors regarding recognition

Community admires a person who works

as a peer educator

Support from family for working as a peer educator

Family knows that I am working as a peer

educator

Ability to work even being a drug user

Acceptance from friends and their family

Feel valuable from work

Importance Satisfaction

Community recognition is also an important factor in motivating peer educators to do their work.

Community admires a person who works as a peer educator received a 4.0 importance score

and a 3.8 satisfaction score.

PSI/Thailand 27

Contrary to the findings from the qualitative study, acceptance from friends and family was

found to be less important than many other recognition specific-motivation factors (mean

importance score=4.0, mean satisfaction score=4.0).

Additional Phase 2 analysis was performed on achievement-specific motivation factors. This

revealed that educators felt proud being a peer educator (mean importance=4.3, mean

satisfaction=4.4). They valued the achievements they receive from being peer educators: be

able to solve friends problems, support them, and be their consultant (mean importance=4.4,

mean satisfaction=4.3) and, rated very highly, the goal of being a peer educator is to improve

friends quality of life (mean importance=4.6, mean satisfaction=4.6).

Graph 6: The importance and satisfaction given by 85 peer educators in

CHAMPION project to the motivation factors regarding achievement

Proud being a peer educator

Be able to solve friends problem, support them and be their

consultant

The goal of being a peer educator is to improve friends quality of life

Importance Satisfaction

Quantitative research found that receiving happiness from work among peer educators working

for the CHAMPION project involves a variety of factors. There are the factors that are due to

working interpersonally, such as helping others and working together with peers who used

drugs. As well as the more self-centered factors from personally developing new skills, gaining

new experiences, and reflecting on ones own problems. Most importantly, the job gives peer

educators pride because they are capable of working and helping other people, resulting in

acceptance and respect from IDU peers, family, and community members. The CHAMPION

project has room to improve upon the acceptance motivation factor.

PSI/Thailand 28

5. Work challenges

However, despite all of the factors that lead to happiness at work, peer educators face various

problems and obstacles. Specifically, these challenges come from the nature of their job (i.e.

doing outreach work), pressure from work and life, personal drug use, relationships with

colleagues, appropriateness of work environment and equipment, capacity building, and

remuneration (i.e. salary).

5.1 Challenges in doing the outreach work

Peer educators in the CHAMPION project reported that they had challenges from the nature of

their job, doing outreach work. Specifically, this included difficulty in attempting to approach

friends who inject drugs, gaining trust from peers and community members, and worry about

police encounters while working.

Peer educators expressed difficulty approaching IDUs, especially those who they had just met

for the first time and have not yet built trust with. They also had difficulty establishing

understanding of their jobs with IDUs family members.

Some cases felt reluctant to disclose themselves. The cases I worked with had disclosed

themselves very recently. Most of our friends did not want to disclose themselves. I had to think

about what I have to do to prepare them, what interventions to use, so that they would decide to

disclose themselves. It was hard for them to decide which decision would be appropriate,

especially when there was someone whom they had not been acquainted with coming in all of a

sudden to ask for their real first and last names and about the UCI. It was hard for them to give

complete data to me.

(PE 1, Male)

It was quite difficult to reach IDUs, because, for the friends who injected drugs, most of them had died already. And for those who were still alive, it was very had to find them. Some of them

had moved to somewhere else, for example, and I had to go visiting them in a new place. But

every time I went there, the only people home was the users parents. And they told me that

their son had gone out already to a specific place. But I kept visiting frequently until I was able to

meet him. ... It was important to discuss with his parents, because otherwise they might think

that I came to deliver drugs, or persuade their son to go for drugs.

(PE 8, Male)

Some peer educators reiterated that gaining trust from IDUs and community members was an

important job challenge. For IDUs in particular, peer educators had to make them believe that

they were not a spy (e.g. an informant or a drug mole) for the police. For community members,

on the other hand, peer educators needed to clarify that their work was at resolving health

problems, not promoting drug use.

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I felt discouraged when friends viewed me as working for a drug mole for the police, that I

would not keep friends secrets confidential. When they said it like this, its impossible for me to

continue doing this job. With a thought like this, some friends declined to trust me. With

regard to people in the community and the head of the village, they also wondered if there was

drug dealing in this house (or this place) because they saw that a lot of people kept coming in

and out. But after I explained to people about what we were doing, or gave an introduction

about the organization to community leaders, they understood everything well. We tried to

disseminate information little by little this way.

(PE 7, Male)

At the moment, community people just keep looking at us without making any comments.

However, some of them do not like us. Some people think that we promote drug use. Anyway,

we have tried to explain that while distributing needles, we also advise how to use needles

properly, and talk about an idea for them to stop injecting due to a lot of dangers and a very high

level of risk from injecting. (We also explained that) distribution of equipment would serve as a

mediator that would lead to a change in injecting behaviors, or that we are doing this with an

aim that our friends would stop injecting.

(PE10, Male)

Peer educators in the CHAMPION project mentioned that the worry about an encounter with

the police while working in the field was an important challenge faced while working, especially

when they carried equipment for distributing to peers.

When I went to work in the field, I would have problems with the police or other people who do

not understand my job. They thought that I promoted drug use among addicts; they wondered

why I took the needles to distribute to friends.

(PE 3, Female)

If policemen are informed about needle distribution, it will be easier. We dont need to talk to

the policemen much. When the police know that we are a peer educator, we will feel free and

comfortable to carry needles. ...When I meet the police in the field while doing outreach work, it

is very boring for me to explain about the content of my work. I was found shoulder bag with

needles, so I told them that I was doing this job. Then they asked where I was going to. I told

them directly that I could not tell because its my friends secret. And then a long explanation

was required after that.

(PE 8, Male)

Im afraid that the police will misunderstand. They may not believe that I will go out to provide

knowledge and to distribute equipment. And in the places where I do outreach work, it is for

sure that drug users are plenty. The police may think that it is true that I will go there to provide

knowledge but at the same time may go there to consume drugs. And they would ask me to

take a urine test,

(PE 10, Male)

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I do not dare to carry a large supply of equipment. For any person who carries needles, the

officials will follow them very strictly. As I mentioned, they would think that, Again! These

persons are coming to distribute the needles again! So, I feel worried that I will have to

encounter the police. When I go out into the field, I carry just enough needles to meet the

demand of friends, not more than 20 needles or 4 packs at a time. Now, I rather distribute the

needles through the health center. I informed the members that if they want some needles, just

go get them there. Its also convenient. However, I still fear when I carry needles. Sometimes

when I do not have enough needles on me, I will fetch the needles from the health center for

them.

(PE 12, Male)

When I carried needles to distribute to friends, it happened so often that I would come across a

police checkpoint and would be arrested, would be forced to take a urine test for narcotics. It

happened so often that I dont want to travel on this route again, because they (the police) do

not have any idea that I am doing this for my job.

(PE 5, Male)

These challenges obstructed peer educators from working to their full efficiency for the

CHAMPION project. For example, this obstacle affected the ability to approach IDUs who had

not disclosed themselves yet and, also, affected the way they worked with local police.

Though the peer educators face challenges while working, based on Graph 3 we know that peer

educators view their job as fun and challenging, the level of satisfaction they gave was still

higher than the level of importance. Therefore, the project should consider finding an approach

to solve the problems related to their performance, so that peer educators can do their job more

efficiently. For example, peer educators should contribute to brainstorming for PR activities for

the project, developing their creditability, and how to solve problems in different situations.

5.2 Pressure from work and other pressures in life

Many peer educators mentioned that they felt pressured by work targets. Additionally, they felt

pressured by the difficulties they faced providing assistance to friends and serving as a

consultant for them.

Sometimes I could not reach my work target, such as 10 persons per each case within 2 days. I

really had no idea where to find that many people. ... For most people who have already

become addicts, it was hard for them to quit. Very few of them were able to quit successfully. I

always told my friends to take care of their health. Just maintain their current health status,

because, once they became addicted to heroin, it would be very hard to quit. So, they should

consume it [injectable drugs] less extensively.

(PE 1, Male)

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Ideally I want drug users to quit completely. However, this seems to be impossible. The best I

can do now is to tell them to take Methadone. I will tell them that if they use drugs, the action of

the drugs will last 2-3 hours. They have to buy it 200-300 Baht a dose and have to buy it again

in less than a day. But Methadone is given for free and for each bottle they take, the action will

last 24 hours. Their life will be better, no need to commit a thievery.

(PE 8, Male)

Some peer educators felt pressured because they kept thinking and worrying about their peers

problems. As a result, peer educators became stressed.

For example, when I saw my friends die, I feel bad. I felt guilty that I was unable to help them.

And I thought further that if I happened to meet them sooner, perhaps I could have saved their

lives. If I had a chance to talk to them (before this), I could have saved their lives.

(PE 3, Male)

I kept thinking about the problems of my friends until I felt stressed. When my friends were ill, I

would already start thinking that they had been infected (with HIV), became ill, and given that

they were drug-dependent, might be craving. So, I kept thinking about what to do, Ask them to

quit? No, thats not right. Ask them to stop using drugs for a while? Again, its not quite right.

Ask them to take a substitute substance? Yes, its lawful. If they would feel better, I would feel

better too.

(PE 7, Male)

Meanwhile, some peer educators also had their personal problems, such as the ones regarding

their family, finance, or relationships with friends. They had to solve their own personal

problems while also helping others.

When I had a problem or felt sad, I tended to consult with my friends who also used drugs,

because we knew well about each others problems. Also, we all accepted that some of us had

family problems. I would never go to consult with a non-user person, because they would not

listen to me. I had to consult friends that belonged to the same group.

(PE 2, Male)

I felt bored, tried and discouraged. I had problems in my life all along. I had no one to turn to,

no one who would listen to me, no real friends, no relatives, not even a mother nor father. I

never received any assistance. They listened and then kept silent, no response to anything. I

told them about various things, such as my financial and accommodation, and employment

needs. (There were) no actions to almost everything I asked.

(PE 10, Male)

Peer educators in the CHAMPION project are both former and current drug users, struggling

with drug use at some point in their lives. This makes drug use a fragile issue for peer

educators. As a peer educator, these workers encounter peers who facing a range of problems.

Therefore, they might develop stress and feel pressured from this. On top of this, they might be

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facing personal problems as well. Therefore, to ensure the effectiveness of their work, its

necessary to provide peer educators with psychological support and any other appropriate

assistance

5.3 Situation of personal drug use

Though peer educators in the CHAMPION project have been trained and provided with

sufficient knowledge on how to serve as a consultant for IDUs, some still were using drugs

because they believed it was impossible to suddenly quit. Pressured by this situation, that they

had to deal with additional feelings, emotions, as well as problems. This personal impact

affected peers educators work.

So far I have been unable to deal with my very own feelings, emotions and problems. So, I

continue getting involved in endless drug use.

(PE 3, Female)

I felt so exhausted dealing with myself. I had tried to quit but never did it successfully. I could

not help crying while I was taking a dose and kept thinking why I couldnt stop (using it). And

when I do this job, people also think that I am an addict. Well, I cant help accepting that I am an

addict but I have been trying to quit. However, they do not believe me. Most users always say

the same as I have just said. So people think that I will never be able to do what I have told.

(PE 10, Male)

Many peer educators reported that, by doing outreach work, they had to be able to control

themselves; because, if they went out working in the field and came across friends who were

taking their doses, the educators might develop a drug craving.

I want to go out in a pair (with a coworker. Because when we see our friends when they are

taking drugs, we must effectively control ourselves. If we go out in pairs of a two at a time, we

can warn each other. Because its so attractive, even a person on parole cant stop himself from

taking (the drugs).

(PE 2, Male)

Sometimes I came across friends who were taking drugs. I just observed to learn what kind of

drugs they were using and the action of that drug, whether it would stimulate or suppress the

(functions of the) nerves. Sometimes they asked me to join them and I joined them too but not

always.

(PE 7, Male)

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My personal drug use is very challenging. When I see friends using drugs in the field, I have to

control myself; otherwise it will affect my work. However, I join them at times. Its really up to

me. I must keep thinking that I am on duty. Drug use has a negative impact if we do not use

it properly. During the period of 5-6 years of my employment, I was affected by my personal

drug use, so I quit. I used drugs so heavily in the past, which caused difficulties for my friends

and