Peer navigators play an integral role in connecting adolescents with clinical care at the AMPATH Rafiki clinic, but what happens to peers as they transition from adolescence to young adulthood and beyond?
The peer navigator program has immense benefits; it provides many young people with a first job that is fulfilling and rewarding, with opportunities for skills building and learning, as well as career exploration. However, peer navigators eventually age out of the program, as it is only for so long that they are of a similar age as the adolescents they are supporting. These peer navigators are trained and perfectly poised to continue their important work at AMPATH in another capacity.
To maintain involvement in AMPATH and transfer and grow skills, some former peer mentors/navigators turn to getting involved in health and HIV-related research at AMPATH as peer researchers or as part of the Adolescent and Youth Research Advisory Board (AYRAB).
Some peer mentors aspire to become investigators who may lead their own research portfolio. On this path, some peer mentors have transitioned to the role of peer researcher to gain experience and build new skills that will support their career development.
Several of the peer navigators at the AMPATH Rafiki clinic have contributed to research being conducted, and have co-authored several papers with Mount Sinai researchers on topics such as sources of perceived stigma, the impact of multimedia teacher trainings on HIV related stigma, and the prevalence of COVID-19 infection among HIV-infected youth during the pandemic.
Dennis is a peer navigator turned peer research assistant whose first contact with AMPATH was as a patient. He became a peer navigator in 2016, and in 2021 transitioned to being a peer researcher after he aged out of the program.
Dennis has very strong relationships in the community, making him excellent at youth recruitment for studies. He has a pulse on the activities at the Rafiki Centre, as well as in the broader Eldoret community, which also helps to inform our study ideas and procedures. As a peer research assistant, Dennis is also very helpful in picking up on the needs of our participants, and the best ways to engage them. His research focuses on engaging children and adolescents living with HIV, and he has co-authored publications concerning adolescent stigma and ethics.
He sat down with Lonnie Embleton PhD, MPH, an Adolescent Health Advisor at the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, and Assistant Professor, Department of Global Health and Health Systems Design, to discuss peer mentors and peer researchers at the Rafiki clinic.
Tell me about what a peer mentor does and your role at Rafiki and AMPATH as a young person?
My role as a peer mentor is linking adolescents to clinicians, especially finding out the things that are hard for the adolescent to tell people, like in school and to other adults. These are topics like stigma in schools, relationships, positive health, dignity, prevention, and how to adhere to medication. The role of a peer mentor is to help them tackle challenges to adherence. Because I’ve walked through the same journey, I have tricks up my sleeves about how to survive and can share those. At the AMPATH facility, we can talk about advocacy, an adolescent’s personal role in their care, and resource mobilization.
So now you’ve transitioned from being a peer mentor to researcher?
Yes. As a peer researcher, I am engaged in recruiting participants, consenting/assenting, and evaluating. In this specific study, we are evaluating and doing interviews with adolescents, and scheduling them for research visits. I also do some data entry, storage, and visualization, mostly within the sphere of research.
What does it mean to be an adolescent/youth peer mentor in Kenya?
During [a community level stigma reduction study study], we trained teachers on how to impact stigma reduction in schools, and created training modules with school teachers. We taught them how, if they find an adolescent living with HIV in the school, they can create a safe environment in the classroom where students feel free to talk about the challenges they face, their relationships, and even feel comfortable enough to disclose their status.
It means a lot that the peer mentors are a part of the research process. Involvement of young people in medical research, such as the introduction of injectable drugs for HIV, often doesn’t happen. Having a peer navigator involved in research allows for that perspective to be present in the development process.
[Another study] looked at some of the challenges that adolescents are facing throughout the COVID-19 pandemic. As a peer researcher, adolescents feel free talking to me; during the pandemic adolescents would open up to me about lacking food or transport and couldn’t travel [to clinic], etc. So being a peer researcher, I understand the challenges that adolescents face easier than a clinician who is checking their viral loads, for example. I bring friendliness to the adolescent, and they are more honest with me with their thoughts than with the others.
What does the day in the life of a peer mentor or researcher working with adolescents living with HIV look like?
We get to impact a person’s HIV care at the clinic, affecting their treatment adherence and their status from not being virally suppressed to being suppressed. It’s satisfying for a young person to go through that journey with the adolescents and find solutions. Just assisting with an adolescent through the journey, helping an adolescent stay negative, who is already infected, is enjoyable.
Nothing about us without us. Working at Rafiki, I get to understand the needs of the adolescents and channel those concerns forward. Whenever the researchers are making policies or programs, they can see what the adolescents need. With this knowledge, we can create adolescent services to fill their unique needs. So, that is most enjoyable. There is also an advocacy aspect—I get to interact with the outside population and understand and correct myths and misconceptions [about HIV].
How has being a peer mentor and researcher changed your life?
I got to learn a lot about how research is done and some of the priorities I need to make for my own future career. I was mentored on how to write an abstract and manuscript, and I got to travel to the 2019 International Conference of AIDS and STIs in Africa to discuss my work and learn from others. It is interesting and empowering to sit down with policymakers at a summit and tell people what would work, and what would not, and what should be prioritized, based on my experience and knowledge. The journey is great, and is helping me figure out which line of medical research I want to work with. I am currently interested in mental health.
What do you envision in your future career?
I am interested in research and, as a peer in research, I want to answer some of the questions and knowledge gaps I see. I think research will empower me to answer questions I have myself. Research tells us why and how we can improve. I am early in my education, and much more interested in those young people, who have not yet graduated with degrees, and how they can implement innovative ideas they have.
What is one thing that you wish people knew about the role of youth peer mentors?
That it’s hard. It is not as simple as it seems to be a peer mentor. You have to understand mental health, medications, BMI and nutrition; you are partly a social worker for adolescents one-on-one to understand what is going on at home. You are a mini-bit of every role in the facility.
People think peer mentorship is simply a young person talking to another young person. But you have a role in everything. With viral load, for example, you know the person’s value and we have to understand what this means; how this pattern reflects the client’s health. Because we do, we can figure out if they need to see a clinician, nutritionist, or a social worker. So, you need to understand all of the aspects of care for a young person to know how to support them and help link them to the care they need when they confide in you.
What are some of the challenges of being a peer mentor?
The challenges are lack of training. In the world of HIV, information is constantly changing. We get stuck with the old recommendations and need updated information. Young people have to look for the information themselves. We need a structured way to get the most up-to-date information as quickly as possible, and a structured way of training. If you are not constantly looking for updates, you will get stuck with the old information because there is no standardized reporting tool. For example, nevirapine [a medication to treat HIV] is still there, but in the process of being phased out.
What motivates you as a peer mentor?
Getting to walk on the journey with young people, because I’ve been there myself. Getting to assist a young person, it feels good to have impacted someone’s life for the better. Now I have networks, and networking with other people gives me insight into what is currently going on, and what I can do in the facility to get on that level and help. Most of the peer mentors are in the community, but we are in the facility, so we are limited in engaging with what other organizations are doing. I’m also motivated by the linkages to attend conferences and HIV workshops–funded by AMPATH.
Outside of being a peer mentor/researcher, what do you like to do?
I play chess, I play football, I like going on trips, taking walks, and long road trips. I enjoy engaging with community-based organizations and other organizations to see what is being initiated and what can I do to facilitate programs that will work in our facility. Some examples include safe spaces, mental health spaces, safe environments for young people, new [treatment] drugs being rolled out, etc. I am also passionate about using digital platforms to empower young people to advocate for healthy behaviors.
A lot of my interests circulate around health. I am also passionate about creating an adolescent camp. It would be interesting; a peer mentor adolescent camp/club, where we could engage for a week or four days outside of the clinic and talk about their challenges. It would be great to have the chance to debrief among peer mentors—we hear and see a lot, but who sees us?
What are three words that best describe you?
Enthusiastic. Self-driven. Creative!
What do you want the world to know about young people and young people in Kenya?
They have the push and the drive to find solutions for themselves. Kenya is a competitive country, every young person has something unique about them. They have grit. Young people are mostly self-driven, with an explosion of ideas to implement. Getting the ability to implement them is a challenge, figuring out how to take their ideas to fruition, so they can make a difference in the community.
Lonnie Embleton, PhD, MPH, is an Adolescent Health Advisor and Assistant Professor, Department of Global Health and Health System Design.
Ava Boal is an Associate Researcher, Arnhold institute for Global Health and Department of Global Health and Health System Design.