Peers play a critical role in supporting young people living with HIV as they navigate the HIV care continuum. Peer mentors, educators, or navigators, are young people of a similar age with shared lived experiences, such as being HIV positive, pregnant during adolescence, and/or being street-connected. Oftentimes the age gap, stigma, or embarrassment prevents adolescents from communicating their needs and concerns with health care providers. Adolescents can communicate candidly and honestly with a peer navigator, who can then help the adolescent get the care and services they need.
The MTRH-Rafiki Centre for Excellence in Adolescent Health, has four peer mentors dedicated to adolescents living with HIV, and two peer navigators dedicated to engaging street-connected young people in HIV prevention and care. Together, these peers work with more than 800 adolescents in the clinic, as well as in the community to conduct home visits to find clients who have missed an appointment. Not only do the peer mentors and navigators improve patient care and drug adherence, but they also create a sense of camaraderie among adolescents attending the clinic and provide a friendly face and safe environment for patients to voice what is going on in their lives without fear of judgment.
Rodney, a peer mentor who has worked at the Rafiki Centre.
In the first of our monthly Peer Spotlight Series, Lonnie Embleton, PhD, MPH, Assistant Professor and Adolescent Health Advisor at the Arnhold Institute for Global Health at Mount Sinai, interviews Rodney, a peer mentor who has worked at the Rafiki Centre for two years. They discuss the role of peer mentors in patient care, both physical and emotional, and the impact that being a peer mentor has had on Rodney’s life. Rodney also illustrates the challenges of being a peer mentor, and talks about what support he and his co-workers need. Peer mentors have an immense positive impact on their adolescent patients, but require support themselves; they are also young adults who have faced adverse experiences and are emotionally affected by the difficult subjects they encounter daily.
Can you tell me about what a peer mentor does and your role at Rafiki and AMPATH as a young person?
As a peer mentor, I talk to clients and bond with them, and when they have an issue that they feel they can’t share with their care worker, they can share it with me. If they don’t want to see someone at the facility, they can make arrangements to see someone locally, and they’ll come for the visit. I can also act as a link between the adolescent client and their parent or caregiver, who they may fear.
Is it hard to talk to the parents? What do you do if this is the case?
Yes, sometimes the parents are very harsh. If so, we refer them to the psychologist, so the psychologist can talk them down.
How did you become a peer mentor?
I was also a patient at Rafiki, and when I became 24, I transitioned to the adult program. They said I might be a good example, so they took me in at Rafiki to become a peer mentor, and I liked the idea. I studied IT, but there are no jobs available, so I am doing the peer mentorship program. If I could get an IT job, I would take it. It is very hard for young people to find jobs, especially without connections or money. We have to go for casual jobs, which are very easy to find but tiresome; someone offers you a job that’s very hard, but pays very little.
What does it mean to be an adolescent/youth peer mentor in Kenya?
Being a peer mentor means I can help people. For example, we had a client, she had lost her home. She brews the local brew and would sell it during breakfast, so she had to skip medications. I helped advise her, and find her something else to do; like a shamba– plant, sell, and earn some money. Now she is doing well, and takes her medications.
Was it hard to become a peer mentor during the pandemic?
Yes, it was. Many people feared the hospital, and we lost many clients to follow-up; we had to visit them in their homes. It’s a challenge when you visit someone, these people [referring to health care providers/ administrators] are sure that if you take a matatu [public minibus], that you will alight at the client’s home. Instead, it is that you alight and then you will take a motorbike and go many kilometers into the village—it is hard to tell the organization and leadership that it is that far. It is sometimes difficult to express to the organization and leaders how hard the job is.
What does a day in the life of a peer mentor working with adolescents living with HIV look like?
When I get to Rafiki, I call clients who have an appointment (prior calling). Then I call those who missed their appointments (defaulter) and find out why they didn’t make it to the clinic and when they are available to reschedule. We also engage adolescents in indoor games like table tennis, although I am still learning how to play! Outside we play football; we have a team that trains from 4 to 6 pm. These activities help to remove the stigma. Rafiki is Rafiki to them, and everyone is friendly. It removes the “I am sick” status.
How has being a peer mentor changed your life?
It has changed my life, and I have lived a positive life. If I can encourage a positive life in the adolescents, and be an example of one, the adolescent will change as well. I gain experience day in and day out. Also, in calling the clients, I speak to parents sometimes; the experience has taught me how to communicate well with parents. I introduce myself: “I am Rodney from Rafiki, I am informing someone about their clinic appointment,” and the parent is thankful.
What is one thing that you wish people knew about the role of youth peer mentors?
They should know that the client trusts the peer mentor, and what peer mentors convey is directly from the client. That we play a very important role in the health care team.
What are some of the challenges young people you work with face?
The adolescents I work with experience fear, stigma, and challenges with getting to the clinic, stress, and peer pressure. They live with their caregivers, and they fear bothering their caregivers for their meals and for help. Another challenge they face is distance to the clinic. When they arrive, they say, “I don’t have a fare to get here.” However, they can go to the social worker, and the social worker can help with their transport fees.
Also, drug and substance abuse occurs. It is very hard for adolescents to talk about it with anyone, but if we approach them in the right way then they do. Some of them drink alcohol, not because they like it, but to relieve their stress. Others drink or do drugs due to peer pressure. Today, I had a patient who was released from prison yesterday.
When in prison do patients experience a disruption of their drug regimen?
Yes, they are disrupted. When they get out, they have to start ART (antiretroviral therapy) again. They have to come into the clinic more, and do viral load testing.
What are some of the challenges of being a peer mentor?
The pay is little, and we need more support as peer mentors. We want to learn and gain more skills in the role as we try to find another job.
What motivates you as a peer mentor? What is your favorite part of working as a peer mentor?
I am motivated by seeing clients very happy as they leave the clinic, and clients doing well. They greet me and tell me I have helped them. My favorite part of working as a peer mentor is visiting someone in their home. I like adventure, and during home visits I get to go visit people in rural areas to find out how they are doing. When you go to their home, you can see if they have trouble out there, and you can say, “yes you really do” (maybe the roads are bad etc.)
Outside of being a peer mentor what else do you like to do for fun?
I like to cook. I cook ugali [corn meal] and chapati [flat bread].
What are words that best describe you?
Laughing. Adventurous.
What do you want the world to know about young people and young people in Kenya?
That they have their own way to express their feelings. Young people are a very different group. They cannot express themselves like adults, and will only express their feelings to people they can trust. This is why peer mentors and navigators are so important.
If you had three wishes, what would they be?
A permanent job. A happy family. And have my own plot.
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.