Peer support in an outpatient clinic for people living with human immunodeficiency virus: a qualitative study of service users’ experiences

Abstract

Background Although human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting. Methods The study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants’ experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories. Results The pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one’s own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support. Conclusions This study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants’ experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.

The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis

“…Therefore, peer volunteers are important resources for providing comprehensive support for PLHIV beyond medical professionals. Many qualitative studies have shown the great necessity of emotional support 51 53–55 69. However, we found only weak evidence that peer support has intervention effects on psychological outcomes.…”

“… 56 76 81 82 Second, access to a safe place reassures both PLHIV and peer volunteers of privacy exposure concerns. 53 Third, more communication between peer volunteers and medical staff is necessary to reduce the information gap and to better integrate volunteers into the clinical setting. 52 55 70 83 Fourth, the context should provide continuous training for peer volunteers to meet their self-growth needs and be more effective in their role as peer supporters.…”

“…It truly does work if peer volunteers just listen to PLHIV to help them alleviate their negative emotions. Other emotional support may include using listening and reflective techniques to help PLHIV gain confidence in their ability to change health-related behaviours48; appealing to PLHIV’s emotions to reinforce or change behaviours53; and demonstrating caring, empathy and comfort to help PLHIV begin to engage in HIV care and treatment 54. Affiliational support aims to help PLHIV reduce isolation and connect to social networks 48 55.…”

“…Although there was limited evidence of effectiveness on psychological outcomes and social outcomes among clinical trials, in qualitative studies, PLHIV reflected that they acquired these benefits. PLHIV reported that peer support can help them reduce loneliness and increase their sense of attachment, sense of belonging, sense of worth, disease acceptance, confidence and hope 51 53–55 69. Social activity engagement was also improved after attending the peer support project 67…”

“…First, the peer support project needs sufficient financial support to pay peer volunteers’ salary and guarantee project operation 56 76 81 82. Second, access to a safe place reassures both PLHIV and peer volunteers of privacy exposure concerns 53. Third, more communication between peer volunteers and medical staff is necessary to reduce the information gap and to better integrate volunteers into the clinical setting 52 55 70 83.…”