“Positive Examples”: A Bottom-Up Approach to Identifying Best Practices in HIV Care and Treatment Based on the Experiences of Peer Educators

Abstract

Literature describing the roles and activities of peers working in HIV care is limited. Evaluations of the impact of peer-based behavior-change interventions reveal mixed results, due in part to varied program aims, structure, evaluation mechanisms, and training. Peers themselves are important resources to address these concerns and lay the groundwork for developing improved programs and evaluation strategies. This qualitative article describes peer support in HIV care and treatment from the perspective of 23 HIV-positive peers across the United States. Peers reported that peer characteristics (HIV-status, common experiences, and self-care) enable them to engage clients. Peers also required flexibility to respond to client needs, and their activities spanned four types of social support: informational, emotional, instrumental, and affiliational. We recommend peer programs and evaluations accommodate the broad scope of peer work by acknowledging the need for flexibility and activities that are not always directly related to clients' HIV care and treatment.

Exploring Perceived Social Support from Peer Facilitators in an HIV Treatment Adherence Intervention for African American Patients: A Content Analysis of Participant Perspectives

“…In the USA, suboptimal adherence, in addition to differences in access to care and treatment delivery, are cited as factors accounting for disparities in HIV treatment outcomes experienced by African‐Americans and other population groups disproportionately affected by the HIV/AIDS epidemic (Cargill, Stone, & Robinson, ; Simoni et al, ). Research indicates that peer facilitators can be effective in helping antiretroviral therapy patients improve their adherence, develop stronger coping skills and reduce negative affect and social isolation (Dutcher et al, ; Koester et al, ; Suwanteerangkul et al, ). Gaining a better understanding of the role played by peer facilitators and how they are perceived by intervention participants is important, given the growing emphasis on treatment initiation and retention in the care of patients soon after an HIV diagnosis (Dieffenbach & Fauci, ; Granich, Gilks, Dye, DeCock, & Williams, ; NIH, ; ONAP, ; Padian et al, ).…”

“…While some qualitative research has addressed how peer facilitators view HIV adherence and coping interventions and their own roles in aiding participants (e.g. Convey et al, ; Dutcher et al, ), we are aware of only one published study to date in the USA that has directed attention to how participants view various aspects of these interventions and their experiences in them (Mitchell et al, ). Participants in that intervention were HIV seropositive drug injection users, but the facilitators were not necessarily HIV seropositive or drug injection users.…”

“…The current study is guided by theoretical and empirical findings from the social support literature. Social support has been linked to favourable health outcomes in medication adherence for HIV and other chronic illnesses (Catz, Kelly, Bogart, Benotsch, & McAuliffe, ; DiMatteo, ; Dutcher et al, ; Edwards, ; Mills et al, ; Simoni, Frick, & Huang, ), as well as psychological functioning amongst persons living with HIV/AIDS (Reich, Lounsbury, Zaid‐Muhammad, & Rapkin, ). According to the direct effects hypothesis (Cohen & Wills, ), social support yields health benefits to individuals when faced with both major stressors and in the absence of them.…”

Building Blocks for Peer Success: Lessons Learned from a Train-the-Trainer Program

“…Regardless of title, peers may serve as mentors and role models, people who are living successfully with HIV and making important contributions to the care and treatment of other persons living with HIV/AIDS. 3 They can provide critical information about HIV disease and treatment adherence without the time constraints faced by many providers. They may help bridge cultural gaps between patients and health care providers.…”

Social Support Networks of People Recently Diagnosed with HIV in Queensland: A Qualitative Exploration

“…Activities designed to support self-management by increasing rates of treatment uptake remain important. However, funding peer-led services to align with biomedical outcomes risks overlooking the most important feature of peer networks that emerged from this research: their nuanced capacity to deliver collective social support that is relevant to the needs of PLHIV (Dutcher et al, 2011). The social resources available within peer communities remain relevant in the chronic condition era, even for PLHIV who are sustaining viral suppression.…”