About the Authors

Sara Graham is the Manager of Peer Support at Living Positive Victoria. She coordinates its Peer Navigation Program and services for women, heterosexual men, and families.

Timothy Krulic is a PhD candidate at ARCSHS. His doctoral research is based on an implementation study of the Peer Navigation Program.

Living Positive Victoria is a peer-based community organisation that supports people living with HIV. The organisation was a pilot site for the W3 Project and established systems to monitor and evaluate its peer programs in collaboration with ARCSHS.

As a result, Living Positive Victoria was well positioned to pivot quickly in response to COVID-19. In this article Sara and Timothy discuss the adaptations its innovative Peer Navigation Program made to support and engage clients throughout 2020.

Living Positive Victoria’s Peer Navigation Program provides peer-based support, guidance, and health system navigation for people living with HIV.

Image of the three Peer Navigators from Living Positive Victoria's Peer Navigation Program: Anthony, Sarah,  and Aashvin.
Anthony, Sarah, and Aashvin from Living Positive Victoria’s Peer Navigation Team.

The program works from the time clients are first diagnosed or contact a clinic. This integration of peer practices into clinical and social services ensures timely access to information and support.

Living Positive Victoria maintains strong partnerships with high-HIV-caseload general practices, hospitals, and specialist clinics across Melbourne. It also has a diverse client base. Roughly 50% of clients are born outside Australia, predominately from Asia. Fifteen per cent are women, 20% are heterosexual men, and 65% are men who have sex with men.

Interim findings from the evaluation trial show that the Peer Navigation Program is associated with significant improvements in quality of life. Clients also showed moderate improvement in:

  • psychological resilience,
  • treatment indicators,
  • confidence engaging in healthcare,
  • and understanding of undetectable viral load.

Clinical partners reported that they value the program as a pathway to high quality community and social services. Staff at no-cost clinics also credit it with improved retention in care — particularly for people experiencing social disadvantage or without access to Medicare. In instances when contact was lost with a client, navigators were able to support reengagement with care.

COVID-19, however, presented the Peer Navigation Program and its clients with some significant challenges

The first lockdown in March significantly changed the way we work. Suddenly, navigators could no longer meet clients in clinical or community settings. We quickly moved all appointments to phone or online. But we also saw a shift in referral patterns and the issues clients need help with.

Fully remote service delivery

The reaction to a fully remote and online service was mixed. Navigators found it difficult to establish rapport with newly diagnosed clients. The lack of in-person communication was also a challenge for people with basic English skills. This was especially the case for people who require interpreters. But we have seen changes over the course of the pandemic.

We have found that women are increasingly more comfortable with engaging online. Heterosexual men are the least likely to want support in this way. These men prefer phone calls or to wait until they can meet in person. Other clients appreciate the increased flexibility. This includes people with limited mobility and people who live regionally or who have work and family commitments. Overall, the program has maintained a steady case load, delivering services to 124 clients since March.

Disrupted referral patterns

This is despite significant disruption in referral patterns. The program saw a decrease in clinical referrals and new diagnoses — except during the brief period of reopening in May and June. In response, Living Positive Victoria grew internal and community referrals from our existing client-base. At the same time, self-referral and referrals from social workers and community service organisations increased.

These new referral pathways reflected a change in presenting issues. Early in the pandemic the program assisted stranded tourists with gaining access to affordable HIV medications. Social support has become increasingly important. Clients experienced more extreme social isolation and the mental health impacts that stem from that. Many lost contact with their usual supports, such as friends and family.

Responding to new client priorities and challenges

The program introduced a system of wellness checks for our vulnerable and socially isolated clients. Peer navigators assisted with the stress of job losses, resurfaced trauma, and the burden of lockdowns on clients and families. Some clients were also concerned that HIV could make them more susceptible to serious illness from COVID-19, which is not the usually the case.

Living Positive Victoria anticipated that clients without access to government support would experience increased financial hardship. This includes international students, asylum seekers, and migrant workers. Peer navigators are active in supporting clients to access financial aid and other supports. The organisation also developed a new financial hardship fund for non-residents. To date, we have helped 46 non-residents with direct payments.

The W3 Framework places emphasis on understanding influence and engagement, and on using these insights to adapt our services

When COVID-19 hit, Living Positive Victoria had the data and processes in place to know who our clients are and track what we do. Importantly, we had the awareness to understand what adaptations would work to meet current challenges and support people to stay healthy.

As lockdowns ease, we anticipate that clinical referrals will increase again. But it’s likely that demand for online and phone appointments and wellness checks will remain. There are clients who have chosen to engage online who may not have pre-COVID. People may be more comfortable with technology and using online platforms as a result of restrictions. Others who may have increased risk of serious illness from COVID-19 may continue to limit their exposure until the end of the pandemic.

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