Using Peers to Improve Sexual and Reproductive Health and Rights of Young People Living with HIV in Uganda: Findings from a Link Up Evaluation

This brief presents the findings of an evaluation of the Link Up project's peer support programme in Uganda, which worked with young people living with HIV (YPLHIV) to improve their sexual and reproductive health and rights (SRHR). The evaluation was conducted by the Population Council, in partnership with Makerere University’s Child Health and Development Centre (CHDC). 

Implemented from 2013 to 2016 in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda, Link Up, a global consortium led by the International HIV/AIDS Alliance, sought to meet the needs of YPLHIV by creating linkages between comprehensive community- and facility-based HIV and SRHR services. In addition, Link Up delivered health education, counselling, and peer support tailored to the needs of YPLHIV in order to educate and empower them to recognise their rights, and feel confident in seeking health services.

The brief describes the peer-based intervention in Uganda, explaining how the programme trained peer educators to connect with networks of new and existing YPLHIV peer support groups, where they would provide health education and counselling on topics relevant to YPLHIV, including relationships, fertility awareness, safe conception, preventing HIV and sexually transmitted infection (STI) transmission, HIV-related stigma, and the rights of YPLHIV to obtain comprehensive SRHR and HIV services. They would also link YPLHIV to facility-based HIV and SRHR services, and provide referral vouchers to be redeemed at partner facilities. A youth-friendly corner was also set up at each of the 12 participating facilities, where young clients could collect educational material or meet with peer educators who were on hand to provide individual or group counselling services. In order to foster a supportive atmosphere and reduce the social barriers to care-seeking that YPLHIV often experience, the project also trained physicians and nurses in participating facilities to prioritise the needs of YPLHIV and deliver confidential HIV and SRHR services in a respectful, non-stigmatising manner.  

The evaluation involved a baseline survey of 473 YPLHIV who attended peer support group meetings. Following the nine-month intervention period, 350 of the original participants were reinterviewed to assess changes in key outcomes, including self-efficacy to engage in healthy behaviours, comprehensive HIV knowledge, condom use at last sex, HIV status disclosure, antiretroviral therapy (ART) uptake and adherence, STI services uptake, and contraceptive prevalence. To inform clinical and counselling practice at the participating facilities, the study also conducted mystery client (MC) observations at ten Link Up partner health facilities.  The evaluation also included  qualitative interviews with YPLHIV, peer educators, and facility providers.

The following are some of the results which are outlined in more detail in the brief:

• Link Up was unanimously appreciated by providers as drawing attention to youth needs and linking HIV/STI services with SRHR services, particularly in government-operated facilities.
• In terms of coverage of the peer-led intervention, almost all participants (97%) reported that they had heard or seen information about the Link Up project; 94% of participants had attended a peer support group meeting at least once in the past nine months; 91% reported that they were currently active members in a peer support group; and 86% had been contacted by a peer educator during the intervention period.
• The evaluation suggests significant increases in the uptake of clinical HIV, STI, and family planning services, including utilisation of STI testing and screening, ART uptake, ART adherence, routine CD4 count testing, and use of modern contraceptives.
• During qualitative interviews, participants indicated that Link Up peer support groups created a welcoming space where YPLHIV felt comfortable sharing the challenges faced in their daily lives, and learned new health risk-reduction strategies. Beyond health-related topics, the support groups often included income-generating activities, which may have generated additional interest and contributed to participant retention in their support groups.
• At baseline, many participants had misconceptions regarding HIV transmission, not only between partners, but also from mothers to their newborns; many assumed that by having a negative sex partner, they would be able to have healthy babies. By endline, participants showed significant improvements in comprehensive knowledge of HIV, self-efficacy, HIV disclosure, and condom use at last sex.