Stepping out of secrecy: heterosexuality, quality of life, and experiences of HIV peer navigation in Australia

Heterosexual people make up a small, but growing proportion of people living with HIV in Australia. This article draws on semi-structured interviews with thirteen heterosexual men and women living with HIV to examine the bearing that sexual identity had on their participation in a peer navigation programme. Our analyses consider the influence of sexuality and gender on the quality of peer relations and the effects of HIV-related stigma on health service engagement and quality of life. Gender and sexuality were significant factors in establishing understanding, acceptance, and community for participants. Having their heterosexuality mirrored by a peer was affirming for men. Women instead emphasised their gendered experiences of HIV. Otherwise, participants' narratives suggested that an experienced peer could reassure, guide interactions with community and services, and ease treatment-related and nonclinical aspects of life. We see peer navigation as a promising intervention to improve the quality of life for heterosexual people living with HIV. Person-centred support from a peer may be particularly important in HIV service environments adapting to the needs of heterosexual people. Peer navigation programmes should promote choice and employ peers of diverse experiences. Implications for referral and the improvement of social services for heterosexual people living with HIV are discussed.

Revealing an enabling environment: How clinical community and clinical stakeholders understand peer navigation to improve quality of life for people living with HIV in Australia

People living with HIV have unique resources to offer each other and health systems. This study investigated how peer navigation might contribute to a socially supportive, health enabling environment in Victoria, Australia. We used semi-structured interviews with 30 program staff, management, peer workers and clinician stakeholders. Our analyses considered the interplay between the program, users, HIV-related stigma and discrimination and the health service environment. Peer relationships offered reassurance, acceptance and belonging, which people living with HIV can use to create personal change. Peer engagement coproduced insights for life with HIV and may help to overcome stigma and structural barriers to access services and community support. As a partnership between peer and clinical services, participants described how the program fostered appreciation of peer practices and insights, which were used to improve the quality and continuity of care offered in the state. These findings allude to the value of the community engagement and policy alignment peer responses produce and can be used to guide implementation of similar programs elsewhere.