Table 3.

Barriers and enablers to PE (N = 83)

	Examples
Barriers
Personal	• Access to and knowledge of PE • Self-efficacy and other commitments • Access to phone and computer
Geographic	• Distance, particularly in rural areas • Access to transportation
Financial	• Lack of resources, including time, space, and money (for programs and peers)
Gatekeepers	• Support from leadership • Blocking from police, city council, and government
Stigma	• Stigmatization of PWUD locally and in society • Lack of community acceptance for PE
Fear of being outed	• Being “outed” via setting and relationships • Breaches of confidentiality in healthcare settings
Enablers
Incentives	• Recognition and value for peers’ expertise • Cash, food, and activities
Consistency	• Stable, consistent, and sustainable opportunities • Consistent people involved
Location	• Inconspicuous location or entrance • A “safe space” identified by PWUD • Close to or access to transportation
The right people	• Committed, compassionate, and knowledgeable staff • Staff with lived experience • Build trust through relationships over time
Peer networks	• Access to information and opportunities • Support and capacity building • Advocacy/organizing