HIV-positive Peer Research Articles

A multi-informant qualitative analysis of desired features for an mHealth tool for youth living with HIV in South Carolina.

Youth living with HIV (YLHIV) in the southern United States experience poor outcomes across the HIV care continuum and are at high-risk for virologic failure. This study used a qualitative, community-engaged approach to inform the development of a tailored mobile Health (mHealth) tool for YLHIV in South Carolina (SC). Semistructured qualitative interviews were conducted with YLHIV in SC (n = 16) and their HIV care providers (n = 15). Focus group discussions (FGDs) were also conducted with HIV-focused community-based organization staff (n = 23). Interviews and FGDs queried desired components for a future mHealth tool tailored for YLHIV. Data were analyzed using a team-based rapid qualitative approach. Across informants, key themes emerged related to medical management of HIV, including a desire for connections with medical providers, appointment and medication reminders, and accurate HIV information. In addition, informants voiced a desire for mental health resources to be integrated into the app. Connection with HIV-positive peers also emerged as a key desire from youth informants. In terms of app design, informants emphasized the need for strict privacy practices, a youth-friendly design, compensation for use, and integration with existing healthcare systems. mHealth interventions developed for YLHIV should meet the mental health and social needs of YLHIV in addition to their medical needs. In addition, the highly stigmatized nature of HIV requires careful consideration when designing digital tools-youth want their privacy prioritized, but also express strong desire for social support to help cope with the isolation and stigma of this chronic health condition.

The moral (bio)politics of the abnormal: Situating a Southwest China border town in global AIDS governance

This paper analyses the interaction of two models in the social process of global AIDS governance and explores the possibilities of innovation in the social response to risk. The two moral regimes by which to cope with problematized situations in the contemporary world are conceptualized as the “center” and the “border”. The center promotes a normative discourse in the name of defending society, reifying order and pursuing cost-effectiveness in operations. The border undertakes exploratory social action guided by a specific idea of “goodness”. While the two approaches engage in continuous battles, with integration and penetration between them, in the case of people living with HIV worldwide, they were first degraded into a separated biomedical pariah population, and then were brought under the strict medical regime of highly active anti-retroviral therapy (HAART). This shift between abject exclusion and exceptional inclusion indicates the meta-structure of life governance in the contemporary world. China's border cities are key outposts of global AIDS governance that reflect how the institutional deployment of exclusion and inclusion extends from global to local. The “ zuo aizibing” (doing AIDS projects) in Biancheng, a Southwest China border town, embody typically as well as uniquely the complicated “center–border” entanglement. Border-organized “infected peer groups” are embedded in the local official governance system, manifesting as “front-line foot soldiers” serving the center by facilitating a smoother integration of the city's HIV-positive population into the public health monitoring system, where they are disciplined to become docile medical subjects. However, such groups, in adaptable symbiosis with this normative deployment, have also been able to independently open up entirely new fields of social action, allowing a humanitarian vision to be mediated, “translated”, and implemented. Through the transmission of knowledge, affection, and vitality, such groups have freed their HIV-positive peers, otherwise abandoned by the normative logic of AIDS governance, from stigmatization and from being limited by disease and treatment, to start pursuing new forms of life. As a global social experiment, the border, as revealed by AIDS, has far-reaching implications for exploring the inclusive and open potential of society itself.

Social Capital in Preventing HIV/AIDS Transmission among Men Who Have Sex with Men [MSM] with HIV in Indonesia

The trend of Human Immonodeficiency Virus/Acquired Immonodeficiency syndrome has become a significant health problem in Indonesia. One of the primary factors contributing to the high transmission of the virus among the HIV-positive population, particularly men who have sex with men (MSM), is their practice of risky behavior. To address this issue, it is crucial to optimize social capital, including both structural and cognitive dimensions, to prevent the transmission of the disease and its progression to the advanced stage (AIDS). Therefore, this study aimed to explain the impact of social capital on in the prevention of HIV transmission among the MSM population with HIV-positive. This qualitative study was conducted in Jember, Indonesia, using a grounded theory approach between April and September 2021. Data were collected using in-depth interviews with 12 HIV-positive MSM obtained using purposive sampling. This study found that social networks were formed through community activities and associations built from participation in social activities, focused on improving the structural dimension of social capital. In the cognitive dimension, trust among HIV-positive peers was related to adherence to ARV treatment, including prevention and transmission. By providing information through both structural and cognitive dimensions, social capital can effectively prevent HIV transmission among MSM HIV-positive and serve as a behavior model in the prevention of the progression to AIDS. Therefore, the education of peers can be developed based on this social capital, providing a basis for effective interventions.

Effectiveness of an HIV prevention program for immigrant Latino men who have sex with men in Canada: Results of a pilot study

This study piloted the GPS (Gay-Positive Sex) Latino program for men who have sex with men (MSM) who immigrated to Canada. GPS Latino is an individual counseling intervention program that involves the provision of information, motivational interviewing, and behavioral skills building to reduce risk behaviors associated with HIV and STI transmission. We designed a pre-post study without control to assess the effects of GPS Latino on depression, loneliness, the self-efficacy of condom use negotiation, and condomless anal sex (CAS). During the study, one HIV-positive peer counselor administered six 2-hour counseling sessions to 11 participants living with HIV and 10 HIV-negative MSM Latinos living in Toronto, Canada. A paired t-test and a McNemar test were employed to assess the effects of GPS Latino twelve months after the start of the intervention. Our study shows a reduction in CAS (any partner) from 90% at the baseline to 62% at the 12-month follow-up ( p = 0.06). The findings also indicate an increase from 19.2 to 21.5 ( p = 0.01) in self-efficacy of negotiating condom use in HIV-negative participants. As a peer-led counseling intervention, GPS Latino may offer an efficient way of concurrently reducing CAS and increasing condom use negotiation in immigrant Latino men who have sex with men.

Training Peers to Ease Hospital Discharge: A Community-Clinical Partnership in Complex HIV Care.

Since many people now live with human immunodeficiency virus (HIV) as a complex, chronic health condition that may require frequent medical and psychosocial services, a potential new role for HIV-positive peers involves support during an inpatient admission that extends past discharge to improve the transition home from hospital. We sought to begin outlining scope of peer support in complex HIV care, by detailing a training curriculum alongside experiences and recommendations by Peer Volunteers. A community-clinical partnership designed a personalized peer intervention for people living with HIV who were acutely hospitalized and struggling with antiretroviral adherence and substance use. Five Peer Volunteers delivered the program, which involved being matched with a participant for a pre-discharge in-person meeting followed by frequent phone contact in the 7 weeks following discharge. A 4-day peer training focused on active listening, structuring a call, use of self, boundaries, and facilitating program closure. The curriculum was informed by theories of change, motivational interviewing, and simulation. Peer Volunteers participated in pre-match and post-match interviews with peer researchers (also living with HIV). Thematic analysis was employed by four independent coders to understand how prepared peers were and areas for program improvement. Peers verified participant feelings and affirmed their experiences, followed-up on participant goals to track progress, disclosed their own relevant experiences to build rapport, and facilitated closure to enable program success. Peers struggled maintaining an emotional connection over the phone and were concerned when participants were nonresponsive. This article discusses how the training was piloted and adapted for practice.

Correction: Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia.

[This corrects the article DOI: 10.1371/journal.pone.0230703.].

Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia.

BackgroundYouth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children’s Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings).MethodsA randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma.ResultsOut of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%)ConclusionsProject YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics.Trial registrationClinicalTrials.gov NCT04115813.

The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis

ABSTRACTThis systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.

Antiretroviral therapy maintenance among HIV-positive women in Ghana: the influence of poverty

ABSTRACTThis study examines the role of poverty in the acquisition of and the adherence to antiretroviral therapy (ART) and prescribed clinical follow-up regimens among HIV-positive women. We conducted in-depth interviews with 40 women living with HIV (WLHIV) in Ghana and 15 stakeholders with a history of work in HIV-focused programs. Our findings indicate that financial difficulty contributed to limited ability to maintain treatment, the recommended nutrient-rich diet, and clinical follow-up schedules. However, enacted stigma and concurrent illness of family members also influenced the ability of the WLHIV to generate income; therefore, HIV infection itself contributed to poverty. To further examine the relation between finances, ART adherence, and the maintenance of recommended clinical follow-up, we present the perspectives of several HIV-positive peer counselor volunteers in Ghana’s Models of Hope program. We recommend that programs to combat stigma continue to be implemented, as decreased stigma may reduce the financial difficulties of HIV-positive individuals. We also recommend enhancing current support programs to better assist peer counselor volunteers, as their role directly supports Ghana’s national strategic HIV/AIDS plan. Finally, additional investment in poverty-reduction across Ghana, such as broadening meal assistance beyond the currently limited food programs, would lighten the load of those struggling to combat HIV and meet basic needs.

HIV sexual risk behavior and preferred HIV prevention service outlet by men who have sex with men in Nigeria

BackgroundThe study objectives were to identify differences in HIV sexual risk behavior of men who had sex with other men (MSM) resident in urban and rural Nigeria, their perspectives on need for HIV prevention services and perceived barriers and facilitators to access of HIV prevention services in private, public and peer-led health facilities.MethodData were collected from MSM resident in urban and rural parts of River and Kaduna States. Qualitative assessment sought perspectives on barriers and facilitators of MSM uptake of HIV prevention services. In addition, a questionnaire was administered to seek information on HIV sexual risk behaviors (sexual abuse, age of sexual debut, multiple sexual partners and use of condom at last sexual intercourse), willingness to use and perceived barriers to access of HIV prevention services in public, private and peer-led health facilities, and willingness to use and perception about availability of structural intervention services. Differences in HIV sexual risk behaviors by residential location, and associations between sexual risk behavior and willingness to access HIV prevention services were determined.ResultsMore MSM resident in urban than rural areas engaged in three or more HIV sexual risk behaviors (25.9% vs 8.7%; p = 0.02). More respondents were willing to access HIV prevention service provided through peer-led health facilities. Less than 35% of respondents identified non-availability of free services as a barrier to HIV prevention service access in the three types of health facilities. More MSM with multiple sexual risk behaviors were willing to access services promoting mental and psychosocial health (p < 0.001), HIV positive peer support programs (p = 0.002) and training on human rights and paralegal services (p < 0.001). Respondents opined that services that assured confidential HIV testing and mitigated structural drivers of HIV infection for MSM provided through peer-led facilities, will increase MSM’s uptake of HIV prevention services.ConclusionHIV risk reduction intervention services differentiated by rural and urban residence, may be needed for MSM. Services provided through peer-led facilities, that include mental and psychosocial health care, peer support, human rights and paralegal services will likely increase its use by MSM with more HIV sexual risk behaviors.

"He Told Me to Check My Health": A Qualitative Exploration of Social Network Influence on Men's HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania.

Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.

Exploring Treatment Needs and Expectations for People Living with HIV in South Africa: A Qualitative Study.

The UNAIDS 90-90-90 treatment targets aim to dramatically increase the number of people who initiate antiretroviral therapy (ART) by 2020. Greater understanding of barriers to ART initiation in high prevalence countries like South Africa is critical. Qualitative semi-structured interviews were conducted with 30 participants in Gugulethu Township, South Africa, including 10 healthcare providers and 20 people living with HIV (PLWH) who did not initiate ART. Interviews explored barriers to ART initiation and acceptability of theory-based intervention strategies to optimize ART initiation. An inductive content analytic approach was applied to the data. Consistent with the Theory of Triadic Influence, barriers to ART initiation were identified at the individual, social, and structural levels. Results suggested high acceptability for intervention strategies involving trained HIV-positive peers among South African PLWH and healthcare providers. Research is needed to evaluate their feasibility and efficacy in high HIV prevalence countries.

Extending beyond Policy: Reaching UNAIDS' Three "90"s in Malawi.

Malawi, like other countries with a generalized HIV epidemic, is striving to reach the ambitious targets set by UNAIDS known as the three 90’s for testing, provision of antiretroviral therapy and viral suppression. Assisted by Malawi’s progressive policies on HIV/AIDS, it appears possible that Malawi will attain these targets, but only by employing innovative program approaches to service delivery which help fill policy gaps. This article describes how a dedicated cadre of layperson testers and HIV-positive peers appears to have helped attain increases in HIV and viral load testing and retention in care in four districts in Malawi, and situates these innovations in a policy framework analysis.

Life begins at 60: Identifying the social support needs of African American women aging with HIV.

HIV chronicity has resulted in increased life expectancy for many African American women who acquired the disease during the epidemic's peak years. As these women live longer and age, their social support needs may increase. Five focus groups were conducted in Washington, DC with 23 HIV-positive African American women aged 52-65 to explore women's perceptions about how aging and HIV chronicity affects their social support needs. Participants were recruited from the longitudinal Women's Interagency HIV Study (WIHS) participant pool. A constant comparison approach was applied during data analysis. Participants reported needing increased social support, especially emotional support from health care providers, family, and HIV-positive peers. The importance of providers and HIV-positive peers was discussed most frequently relative to meeting these needs. Health care providers in particular may need to increase their provision of emotional support when devising treatment plans to meet the social support needs of older HIV-positive African American women.

Shared Illness and Social Support Within Two HIV-Affected African American Communities.

A key source of resiliency within HIV-affected African American communities is informal social support. Data from dyadic conversations and focus groups were used to address the following research question: What are HIV-positive African Americans' social support experiences within their informal social networks in response to HIV-related problems? Circumstances that exacerbated HIV-related problems included others' fear of contagion, reticence to be involved, judgment and rejection, and disregard for privacy Support from HIV-negative others buffered the impact of problems when others communicate interest, take the initiative to help, or make a long-term investment in their success. Support from other HIV-positive persons was helpful given the shared connection because of HIV, the opportunity to commiserate about what is mutually understood, and the fight for mutual survival Based on these findings, we offer suggestions for future research and social network interventions aimed at bolstering connections between HIV-positive peers, reducing stigma, and improving family support.

HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.

BackgroundU.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing “Data to Care” programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program.MethodsDisease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009–2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015.ResultsPLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV-positive peer component and to ensure coordination with HIV care providers in the process of relinking patients to care.ConclusionsHealth departments can build support for Data to Care efforts by gathering input of key stakeholders, such as HIV medical and social service providers, and coordinating with clinic-based efforts to re-engage patients in care.

Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers.

Improving patient engagement in HIV care is critical for maximizing the impact of antiretroviral therapy (ART). We conducted a systematic review of studies that used HIV-positive peers to bolster linkage, retention, and/or adherence to ART. We searched articles published and indexed in Pubmed, PsycINFO, and CINAHL between 1996 and 2014. Peers were required to be HIV-positive. Studies were restricted to those published in English. Nine studies with n=4658 participants met the inclusion criteria. Peer-based interventions were predominantly focused on improving adherence to ART, or evaluations of retention and adherence via viral suppression. Five (56%) were conducted in sub-Saharan Africa. Overall findings were mixed on the impact of peers on ART adherence, viral suppression, and mortality. While positive effects of peer interventions on improving linkage and retention were found, there were limited studies assessing these outcomes. Additional research is warranted to demonstrate the impact of peers on linkage and retention in diverse populations.

Peer supporter experiences of home visits for people with HIV infection.

PurposeThis study’s purpose was to explore the experiences of peer supporters regarding their work in a home visit program for people with HIV infection.Patients and methodsA qualitative descriptive study was conducted using focus groups. Participants were 12 HIV-positive peer supporters conducting home visits with people living with HIV/AIDS in South Korea. Thematic analysis was used to analyze the data.ResultsSix major themes emerged: feeling a sense of belonging; concern about financial support; facing HIV-related stigma and fear of disclosure; reaching out and acting as a bridge of hope; feeling burnout; and need for quality education. The study findings indicate that although peer supporters experience several positive aspects in the role, such as feelings of belonging, they also experience issues that make it difficult to be successful in the role, including the position’s instability, work-related stress, and concerns about the quality of their continuing education.ConclusionThe findings suggest that to maintain a stable and effective peer supporter program, such positions require financial support, training in how to prevent and manage stress associated with the role, and a well-developed program of education and training.

Improving Outcomes for Adolescents With Drug-Resistant Tuberculosis

As Moyo and colleagues’ research illustrated, we must improve outcomes for the estimated 655000 adolescents living with drug-resistant tuberculosis (DR-TB) (1). Several challenges, including those described by Moyo and colleagues, contribute to current abysmal outcomes, such as the treatment success rate of only 36% in this retrospective cohort. Understanding and addressing these challenges in both TB research and programming can ensure earlier detection, higher retention in care and better cure rates for adolescents with DR-TB, both with and without HIV infection. Community-based treatment support and care programs have been implemented to address issues of adherence to treatment and retention in care for adolescents living with HIV. In Zimbabwe, Africaid’s Zvandiri program, led by HIV-positive children and adolescents, works to ensure a robust continuum of care between clinic and community for adolescents and children living with HIV. The Zvandiri program operates in close collaboration with the ministry of health and child care and government and private clinics. Community adolescent treatment supporters (CATS) receive training to provide community based treatment adherence support and counseling for HIV-positive peers. Peer-led interventions provide continuous support to affected adolescents, which can help improve treatment adherence and reduce stigma associated with HIV and TB. Successful models of HIV treatment support should be adopted for adolescents undergoing treatment for DR-TB, which can last two years and result in significant side effects, some of which last beyond the end of treatment. Several factors believed to affect adolescent treatment success rates, including stigma and major life changes such as moving, finding work and developing significant relationships and long-term commitments, might be mitigated with the development of treatment regimens that are shorter, more effective and have fewer side effects. Two new drugs, bedaquiline and delamanid have been finally approved to treat DR-TB and several phase III DR-TB treatment-shortening studies are planned or already under way. Inclusion of adolescents in phase III treatment-shortening studies should be encouraged as there is no physiological basis for their exclusion. Adolescents achieve similar levels of drug exposures as adults, present with similar forms of TB disease and tolerate adult formulations. It is imperative that sponsors of new drugs and trials testing new combinations include adolescents in their studies. Both end TB (which plans to test five all-oral, nine-month regimens containing either bedaquiline or delamanid in people with multidrug-resistant TB) and NIX-TB (which is evaluating a six-to-ninemonth regimen of bedaquiline, new drug candidate pretomanid and linezolid in people with extensively drug-resistant TB) include adolescents down to 15 and 14 years old, respectively (2-4). Inclusion of adolescents in late-stage trials would help to expedite access to new, shorter and improved regimens for the large population of adolescents at increased risk of treatment failure and poor treatment outcomes under existing DR-TB therapies.

Peer mentors, mobile phone and pills: collective monitoring and adherence in Kenyatta National Hospital's HIV treatment programme

In 2006, the Kenyan state joined the international commitment to make antiretroviral treatment free in public health institutions to people infected with HIV. Less than a decade later, treatment has reached over 60% of those who need it in Kenya. This paper, which is based on an in-depth ethnographic case study of the HIV treatment programme at Kenyatta National Hospital, conducted intermittently between 2008 and 2014, examines how HIV-positive peer mentors encourage and track adherence to treatment regimens within and beyond the clinic walls using mobile phones and computer technology. This research into the everyday practices of patient monitoring demonstrates that both surveillance and adherence are collective activities. Peer mentors provide counselling services, follow up people who stray from treatment regimens, and perform a range of other tasks related to patient management and treatment adherence. Despite peer mentors’ involvement in many tasks key to encouraging optimal adherence, their role is rarely acknowledged by co-workers, hospital administrators, or public health officials. Following a biomedical paradigm, adherence at Kenyatta and in Kenya is framed by programme administrators as something individual clients must do and for which they must be held accountable. This framing simultaneously conceals the sociality of adherence and undervalues the work of peer mentors in treatment programmes.