The Changing Needs of Peer Support Among Gay Men Living with HIV in Australia: A Reflexive Thematic Analysis

Overview

Journal Arch Sex Behav

Specialties Psychiatry
Social Sciences

Date 2025 Feb 11

PMID 39934588

Authors

Neil Lucas

Glen Bates

Simone Buzwell

Affiliations

Soon will be listed here.

Abstract

Despite a significant decline in HIV transmission in Australia, many people living with HIV continue to face stigma and discrimination. For gay men, historically at high risk for HIV, peer support programs are essential to improve psychosocial outcomes. Peer support is known to reduce stigma demonstrably, improve well-being, increase medication adherence, and connect participants to broader HIV services. While peer support is known to be important within the HIV care continuum, there is little research on factors associated with engagement with peer support and no Australian study has examined determinants of involvement. This study focused on Australian gay men living with HIV for at least five years to understand the factors impacting engagement, retention, and attrition. Twenty participants with 5-36 years of lived experience participated in semi-structured interviews. Reflexive thematic analysis revealed four key themes: (1) shared experiences, (2) confidentiality and trust, (3) changing needs with aging, and (4) inclusion and collaboration. The themes highlight the importance of fostering connection, trust, program adaptability, and agency. Barriers to engagement included problems with online support access due to cost, limited technological proficiency, and concerns about program relevance for aging men who have extensive HIV lived experience. The findings underscore the need for consistent funding to support well-defined program scopes that cater to diverse and changing needs. Such enhanced program support is crucial to address the specific requirements of men with long-term experience of living with HIV as they age through the HIV care continuum.

References

Berg R, Page S, Ogard-Repal A . The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One. 2021; 16(6):e0252623. PMC: 8211296. DOI: 10.1371/journal.pone.0252623. View

Bor J, Fischer C, Modi M, Richman B, Kinker C, King R . Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and "Undetectable = Untransmittable": A Systematic Review. AIDS Behav. 2021; 25(12):4209-4224. PMC: 8147591. DOI: 10.1007/s10461-021-03296-8. View

Brashers D, Basinger E, Rintamaki L, Caughlin J, Para M . Taking Control: The Efficacy and Durability of a Peer-Led Uncertainty Management Intervention for People Recently Diagnosed With HIV. Health Commun. 2016; 32(1):11-21. DOI: 10.1080/10410236.2015.1089469. View

Broady T, Cama E, Brener L, Hopwood M, de Wit J, Treloar C . Responding to a national policy need: development of a stigma indicator for bloodborne viruses and sexually transmissible infections. Aust N Z J Public Health. 2018; 42(6):513-515. DOI: 10.1111/1753-6405.12809. View

Bulsara S, Wainberg M, Audet C, Newton-John T . Retention in HIV Care in Australia: The Perspectives of Clinicians and Clients, and the Impact of Medical and Psychosocial Comorbidity. AIDS Patient Care STDS. 2019; 33(10):415-424. DOI: 10.1089/apc.2019.0094. View

Barbosa H, Oliveira J, da Costa J, Santos R, Miranda L, Torres H . Empowerment-oriented strategies to identify behavior change in patients with chronic diseases: An integrative review of the literature. Patient Educ Couns. 2021; 104(4):689-702. DOI: 10.1016/j.pec.2021.01.011. View

Chan R, Mak W . Protective and Compensatory Effects of Group Identification on the Mental Health of People Living with HIV. Arch Sex Behav. 2020; 50(4):1677-1687. DOI: 10.1007/s10508-020-01823-7. View

Cosentino F, Marino A, Anile L, Moscatt V, Gussio M, Boscia V . Long-Term Survivors in a Cohort of People Living with HIV Diagnosed between 1985 and 1994: Predictive Factors Associated with More Than 25 Years of Survival. Infect Dis Rep. 2023; 15(1):70-83. PMC: 9957088. DOI: 10.3390/idr15010008. View

Dawe J, Cassano D, Keane R, Ruth S, Wilkinson A, Elsum I . Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing. HIV Med. 2023; 24(12):1253-1267. DOI: 10.1111/hiv.13592. View

10.

Deeks S, Lewin S, Havlir D . The end of AIDS: HIV infection as a chronic disease. Lancet. 2013; 382(9903):1525-33. PMC: 4058441. DOI: 10.1016/S0140-6736(13)61809-7. View

11.

Earnshaw V, Lang S, Lippitt M, Jin H, Chaudoir S . HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources?. AIDS Behav. 2014; 19(1):41-9. PMC: 4378835. DOI: 10.1007/s10461-014-0758-3. View

12.

Feinstein B, Hall C, Dyar C, Davila J . Motivations for sexual identity concealment and their associations with mental health among bisexual, pansexual, queer, and fluid (bi+) individuals. J Bisex. 2021; 20(3):324-341. PMC: 7958702. DOI: 10.1080/15299716.2020.1743402. View

13.

Friedman M, Liu Q, Meanley S, Haberlen S, Brown A, Turan B . Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health. 2022; 112(S4):S452-S462. PMC: 9241468. DOI: 10.2105/AJPH.2022.306735. View

14.

Han S, Zhang Y, Yang X, Chai X, Guo J, Zhang L . The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis. BMJ Glob Health. 2023; 8(2). PMC: 9943909. DOI: 10.1136/bmjgh-2022-010966. View

15.

Hibbert M, Crenna-Jennings W, Kirwan P, Benton L, Lut I, Okala S . The people living with HIV stigma survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay and heterosexual men. AIDS Care. 2018; 30(9):1189-1196. DOI: 10.1080/09540121.2018.1479027. View

16.

Holt M, Lea T, Schmidt H, Murphy D, Rosengarten M, Crawford D . Increasing Belief in the Effectiveness of HIV Treatment as Prevention: Results of Repeated, National Surveys of Australian Gay and Bisexual Men, 2013-15. AIDS Behav. 2016; 20(7):1564-71. DOI: 10.1007/s10461-016-1306-0. View

17.

Jayakody D, Tan Y, Livings I, Costello L, Flicker L, Almeida O . Australian older adults' views on using social media for reducing social isolation and loneliness in hearing impaired older adults: A community conversation. Australas J Ageing. 2022; 41(4):585-589. PMC: 10087692. DOI: 10.1111/ajag.13137. View

18.

Kay E, Rice W, Crockett K, Atkins G, Batey D, Turan B . Experienced HIV-Related Stigma in Health Care and Community Settings: Mediated Associations With Psychosocial and Health Outcomes. J Acquir Immune Defic Syndr. 2017; 77(3):257-263. PMC: 5807196. DOI: 10.1097/QAI.0000000000001590. View

19.

Keogh P, Dodds C . Tempering hope with Intimate Knowledge: Contrasting emergences of the concept 'uninfectious' in HIV. Sociol Health Illn. 2021; 43(5):1100-1116. DOI: 10.1111/1467-9566.13264. View

20.

Krulic T, Brown G, Graham S, Hoy J, Bourne A . Revealing an enabling environment: How clinical community and clinical stakeholders understand peer navigation to improve quality of life for people living with HIV in Australia. Front Public Health. 2023; 11:1101722. PMC: 10157390. DOI: 10.3389/fpubh.2023.1101722. View