Living the work: Internal and identity challenges of adolescent peer navigators living with HIV

Adolescent peer navigators living with HIV play a vital role in linking clients to care, supporting adherence, and humanizing HIV services. Their value stems from lived experience-an identity that both empowers and leaves them vulnerable. While research highlights their contributions, less is known about how navigators experience the personal and emotional demands of their work. This study explores how they make sense of supporting adolescents while managing their own HIV-related vulnerabilities.

Through the AMPATH Kenya research network, we conducted in-depth interviews with 30 participants: 11 current peer navigators (55% female, median age 25), 6 former peers (33% female, median age 31), and 13 supervising healthcare workers (100% female) at two adolescent HIV clinics. Interviews explored role identity, emotional labor, stigma, and wellbeing. Data were analyzed using Interpretive Phenomenological Analysis to capture participants' meaning-making around supporting adolescents while negotiating their own identities and life trajectories.

Peer navigators described a continuous balancing act between personal HIV experience and professional responsibilities. Three interconnected themes emerged: (1) "living openly, living carefully"-strategically managing disclosure to build trust while minimizing stigma; (2) "you can't pour from an empty cup"-absorbing adolescents' crises while suppressing personal distress; and (3) "I am proof that life goes on"-deriving empowerment and affirming resilience through helping others. Healthcare workers highlighted the emotional demands of the role and the expectation that peers model stability.

Peer navigation relies on relational labor and lived experience, not just training. Sustaining this workforce requires mentorship, emotional support, and clear professional pathways to help peers manage personal vulnerability while supporting adolescents effectively.