AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #189 - Changes in peer work or volunteer status over time among HIV-positive peer advocates serving at-risk populations throughout the United States
Authors: Presenting Author: Ms. Sarah Goldenkranz - Center for Health Training
Additional Authors: Dr. David Fine, Dr. Carol Tobias, Ms. Serena Rajabiun, Dr. Paul Colson, Dr. Julie Franks, Dr. Brenda Loscher,
Aim: Growing evidence shows HIV+ peer advocates positively impact patients’ HIV care. However, peers are not broadly accepted as formal members of care-teams for HIV+ patients in United States (U.S.) healthcare systems. We describe fluctuations in peer work/volunteer status among HIV+ peers serving populations disproportionately affected by HIV (racial/ethnic minorities; women) throughout the U.S., and explore factors associated with fluctuations in peer work/volunteer status.
Method / Issue: With U.S. federal funding, the Peer Education Training Sites Initiative (2005-2011) recruited and trained HIV+ men and women from at-risk communities across the U.S. interested in becoming or currently serving as peer advocates. Questionnaires at baseline (pre-training), 6-month, and 12-month follow-up solicited peer work/volunteer status during the last six months. Response options were: ‘worked as peer’, ‘volunteered as peer’, or ‘did not work or volunteer as peer’. Response patterns across the three survey timepoints are described. Univariate and multivariate analyses explored associations with peer demographics (including Spanish as primary language), health (insurance status, AIDS diagnosis, HIV/AIDS knowledge, self-care), and geographic region.
Results / Comments: Of 291 respondents, median age=45 years; 65% were female; 17% Hispanic, 52% black; 43% attended some college; 76% received public health insurance; median time since HIV diagnosis=11 years; geographic region: Midwest=34%, Northeast=24%, South=16%, West=25%. At baseline, 21% worked as peers, 35% volunteered as peers, and 44% did neither. 51% of peers reported consistent work/volunteer status throughout follow-up. Of the remaining peers, 66% reported a single change in work/volunteer status and 34% reported multiple changes. Overall, 27 different work/volunteer status patterns were identified. Changes in work/volunteer status were reported by 39% of those working at baseline, 58% of those volunteering at baseline, and 48% of those neither working nor volunteering at baseline. Of 127 peers not work/volunteering at baseline, 47% transitioned to volunteering or working within 6-12 months, however, 25% started at 6 and had stopped again by 12 month follow up. Of 102 peers volunteering at baseline, 29% reported working and 35% reported not working/volunteering at least once during follow-up. Of 62 peers employed at baseline, 31% reported volunteering and 15% reported not working/volunteering at least once during follow-up. In multivariate analyses, any change in peer work/volunteer status was positively associated (p<0.05) with: living in Northeastern U.S. (AOR=2.44), HIV diagnosis <5 years from enrollment date (AOR=2.58), and AIDS diagnosis (AOR= 1.80).
Discussion: Only half of HIV+ peers maintained consistent peer work/volunteer status throughout 12 months follow-up. Peers residing in Northeast, recently diagnosed with HIV, or in poorer health were most likely to change work/volunteer status. Status changes likely reflect both individual and system/agency characteristics (e.g. impact of U.S. economic conditions on agency’s funding for peer positions). Important programmatic implications include: potential disruptions to clients’ continuity of care, need for on-going support systems for peers, and agency costs associated with training replacement peers. Measuring peer work cross-sectionally may not reflect actual work/volunteer patterns over time, necessitating frequent monitoring and evaluation of peer programs. Further research to explore reasons for fluctuations and improve continuity of peer service would benefit clients and agencies.
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