Work without a roadmap: A qualitative analysis of occupational and structural challenges among adolescent peer...

Peer navigator programs are central to adolescent HIV service delivery across sub-Saharan Africa, particularly within differentiated and community-based care models. While evidence demonstrates their effectiveness in improving engagement, retention, and psychosocial support, less attention has been paid to the labor conditions under which peer navigators operate. Drawing on feminist political economy, this study examines how peer navigation is organized, experienced, and sustained within resource-constrained health systems.

In-depth interviews were conducted with 30 participants at two HIV clinics in western Kenya: current peer navigators (n = 11, 55% female, median age 25), former peer navigators (n = 6, 33% female, median age 31), and healthcare workers (n = 13, 100% female). Interviews explored the structure, expectations, and lived experiences of peer navigation roles. Data were analyzed thematically, with attention to the temporal, economic, gendered, and professional dimensions of peer labor.

Peer navigation was described as meaningful and impactful work structured by layered forms of precarity. Four key themes emerged. First, peer navigators experienced "boundary-less" work characterized by continuous availability and emotional labor extending beyond formal hours, absorbing gaps in under-resourced health systems. Second, compensation was stipend-based, producing financial insecurity, limited benefits, and constrained capacity for self-care, while moral narratives of "helping" obscured structural inequities. Third, female peer navigators described gendered vulnerabilities, including sexualized expectations, harassment, and safety risks, often without formal protections. Fourth, participants highlighted the absence of clear professional pathways, with limited opportunities for advancement or integration into the formal health workforce.

Peer navigation functions as undervalued care labor sustaining HIV services in resource-constrained settings. As peer-based models scale, sustainability must include fair compensation, formal protections, supervision, and structured career pathways.