Peer navigators play an integral role in the care provided to adolescents at the AMPATH Rafiki Clinic. The peer navigators at the MTRH-Rafiki Centre for Excellence in Adolescent Health serve more than 800 adolescents who have shared lived experiences, such as living with HIV, experiencing pregnancy during adolescence, and/or being street-connected.
Peer navigators create a sense of community in the clinic, a space without judgment where adolescents can interact and receive care without the burden of stigma. They connect adolescents to appropriate care services, improving engagement in care and subsequent care outcomes.
When the Rafiki Center Peer Navigator program first began in 2016, it consisted of only two peer navigators, one female and one male. Whitney was the first female peer navigator at Rafiki, and Ashley Chory, Senior Program Manager for Global Adolescent Health at the Arnhold Institute. Whitney served as a peer mentor at the Rafiki Center for three years, then transitioned to the role of study peer/peer researcher, working to help engage adolescents in research, especially those who may be harder to reach.
Ashley Chory
In this interview, Whitney discusses the impact that being a peer navigator has had on her life, HIV-related stigma and how it affects the peer navigator role, and the opportunities that working at the Rafiki Center has brought her. Whitney suggests possible improvements for the peer navigator program, such as integrating the program into the clinic more seamlessly, reducing provider stigma, and how to better support peer navigators employed at Rafiki.
What is a Peer Navigator?
A peer navigator is a young woman or man who helps a young person in care navigate the care system. Every time they have challenges, we are there for them and basically support them through the experience, because we speak the same language. Peer navigators are the bridge between adolescents and the clinic system and school, and with their parents.
Tell me about what a peer navigator does and your role at Rafiki and AMPATH as a young person.
Peer navigators worked at module 4 [the pediatric unit at Moi University Hospital] before the adolescent clinic was open. Module 4 is now a clinic for children from birth to 15 years old, before they are disclosed [made aware of their HIV status]. They transition to Module 4 after testing positive [for HIV] at the mother-child clinic. When I worked at module 4, it served those up to 24 years old (before the Rafiki center). I was one of the first peer mentors for adolescents at AMPATH.
My responsibilities as a peer navigator include giving group health talks to adolescents related to HIV management, facilitating group pre-test HIV education and psychosocial support, co-facilitating support groups, and providing one-on-one peer education to adolescent clients and their partners. I conduct tracing of priority adolescent clients who have not shown up to an appointment, refer adolescent clients to other services within the health facility, and encourage partner involvement in maternal child health and family planning services.
[At the Rafiki Center] the first person an adolescent meets is the peer. We talk about school, home. In the beginning of the program, counseling was not a choice, it was a part of engagement in the clinic. Now, you must have an issue before you join counseling, which is a barrier to receiving mental health care due to stigma and logistical barriers. We must create a safe space and guide the adolescents to counseling, referring them to care while maintaining confidentiality.
How long have you been a peer navigator at Rafiki/AMPATH?
I was a peer mentor for three year, and then transitioned to a study peer. Study peers help reach adolescents who may be interested or eligible to participate in research but may be harder to reach. Study peers follow the participant from care through to enrollment and participation in the study, and they help adolescents feel safe in sharing information.
How has being a peer navigator changed your life?
Being a peer navigator helped me accept myself, and gave me confidence to do things I didn’t think I could do. It also provided me with a platform where I can meet and interact with other peers. I learned a lot about peer mentoring, beyond the program for adolescents. The program helped me transition from peer mentor, to study peer, to the current day where I am going back to school to get a diploma in counseling. Peer mentoring is not the end goal, it is a stepping stone on my career path.
I don’t think I would have had the same opportunities if I wasn’t a peer—I have attended conferences, symposiums, have talked and presented for the county Ministry of Health, and have learned from many leaders in adolescent health. Every day I am motivated that there is more coming, and I will have new ideas and come back and share them.
What motivates you as a peer navigator?
How I am able to talk to an adolescent—I admit them, they look bad, they have no [medication] adherence, and I go through the whole process with them until I see that they are well and healthy and they are talking a lot. I oversee their care from day one of their hospital admission to their discharge, to their care at the clinic and good medication adherence. And then I can rest at night knowing I just changed my patient’s perspective on life. There are so many adolescents who come in and are doing so badly—I work with them and then they are better. I am also motivated by how my fellow peers treat me like their role model. They look up to me for advice, and I am always available for them to reach, unlike some nurses and doctors
How did being a peer mentor help you accept yourself?
Before, I didn’t see a role model for young people living with HIV. Peers can help. When I was younger, I did not have anyone who was living with HIV (and was not ashamed of it) for me to look up to. Previously I was too shy to talk about anything, about my story, and peers help normalize this life experience. I am no longer sad or crying, but laughing. It helped me with my self-worth. Now when I look in the mirror, there is nobody that can tell me anything about myself. I get sentimental watching other adolescents go through this.
What opportunities do you see for expansion of the clinic’s services?
The clinic needs more activities beyond clinical care. The way the country is going, adolescents are suffering to get jobs and to fit in. There are youth who have support from their parents, and others who do not. The clinic is a good setting to provide training that helps.
Adolescents sometimes forget what their purpose is in life. Peers can intervene to help adolescents figure out their goals, and use the clinic to push toward their goals. Peers need help transitioning into other things—skill building, and finding other opportunities. They need to be told to go back to school, so that they can be a model for younger adolescents. We should add other classes (they have planting now), to build skills. Adolescents don’t always know what classes are available to them. The classes should be tailored to ensure each and every adolescent belongs to a group and visits the Rafiki center during school breaks so they can learn when they have time.
Peer navigators should be more integrated into the clinic. Providers can be dismissive of peer navigators, which makes it hard to work together, despite the fact that they are all there for the same reason: adolescents. The Rafiki center has providers who are cool—they sometimes wear jeans—you think you are just at home.
There are many peer navigators now, maybe we can have a training where we get all of the peers from the different counties together in Eldoret, once a year. To network, learn from others, dance, etc. People can then go and actualize the ideas in their clinics. “Aging as a peer navigator” is a possible topic for exploration.
What is one thing that you wish people knew about the role of youth peer navigators?
Being a peer navigator does not exclude you from stigma—I am glad I can be a peer navigator because I can correct things that happen in the health care setting that are stigmatizing. We can air out some of the differences and problems that we see, and make it better for the younger kids. As one of the first peer navigators, I did not have an example or mentor for me to look up to. It took a lot of guts and self-talk to do it. Something you need to carry yourself, and do wholeheartedly—it is a calling, it is not a job.
Regarding stigma—We work with nurses, doctors, and outreach workers and sometimes they can be stigmatizing. If you ask a question, they may respond dismissively because of one’s HIV status. They are supposed to help you. They are the same people who tell clients that some employees are living with HIV—outing people, creating confidentiality issues between patients and providers. Peer navigators still feel the stigma, but you have to talk yourself out of it, because you are someone’s role model.
When peer navigators first began working at the Rafiki center, there was a question about whether they should be paid, or not, stipend or not. Getting a small stipend motivated me to be able to study, support my family. I still think they should provide more financial support. They are not just adolescents here to do this and that.
What is your favorite thing about working as a peer navigator?
Seeing a smile on a parent’s face. There were times when parents came to me to see what was happening with their child. That smile, after you’ve sorted out the adolescents—like checking in on a pregnancy scare, etc.—it is fine, they are all fine. Making the caregiver happy, it gives me happiness.
Looking back at how the peer navigator program has expanded makes me so happy. It used to be much smaller, there were just two of us, but now there are many, for all of the different kinds of needs. It has grown so much and that makes me so happy. I’m happy that the peer navigator program is a success. And all that we’ve been able to do in such a short time—getting adolescents [virally] suppressed, getting adolescents who were lost to follow up to come back to clinic, and adolescents joining the many psychosocial groups. My favorite thing is handing over the job and mentoring younger up-and-coming peer navigators at the clinic.
Outside of being a peer navigator what are you doing (such as school/education, working, parenting, looking for work)?
I transitioned to the research department working as a peer researcher. [Whitney has worked as a peer mentor on several studies, focused on addressing HIV stigma in the classroom, developing educational strategies to combat HIV stigma, assessing the impacts of the pandemic on Youth Living with HIV (YLWH), and examining stakeholder perspectives on reducing stigma in Kenya.] I’ve just received a diploma in psychological counseling. My goal in life is to start a clinic for mental health counseling for young people. I am also a commercial model, and a content creator. And I am an excellent makeup artist.
What are some words that best describe you?
Down to earth, outgoing, bubbly, jolly.
What do you want the world to know about young people and young people in Kenya?
Young people are special. They need to be understood, and given opportunities, as many as they want. They are in the midst of dealing with puberty, relationships, mental health struggles, and discovering themselves. They need nurturing, support and love from the people around them in order to make them better people. School, home, and clinic should all come together to support adolescents and support their goals. At the clinic, we are trying our best to support them—the school and their parents should do the same.
If you had three wishes, what would they be?
I wish there were no sicknesses in this world. I wish for many more wishes, so that I can cure the world.
Ashley Chory, MPH, is Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Ava Boal is an Associate Researcher.