Empathic response and no need for perfection: reflections on harm reduction engagement in South Africa

The importance of community involvement in public health research processes is well established. The literature is, however, less forthcoming about processes of community inclusion in public health project implementation, especially when it comes to projects focusing on key populations. The Step Up Project is the first multi-city harm reduction service provision project for people who inject drugs in South Africa. Since inception, the Project has made concerted efforts to work with and alongside people who actively identify as people who inject drugs. This paper outlines two features in relation to project-beneficiary dynamics that emerged in a qualitative project evaluation conducted by an external researcher and a funder representative. The first was that people accessing the project comfortably expressed criticisms of both themselves and the project, and noted when their behaviour contradicted project ideals. The second was the extent to which engagement with the project was reported to be fostering a renewed sense of personhood and right to exist in the world. These findings are, we suggest, in principle related to two forms of community engagement: consistent empathic response and community advisory groups. This implies that programmes need to focus on their mode of approach as much as on the content of their approach. It further implies that programme impact not be limited to quantitative assessment measures.