Ahead of World AIDS Day next week, we’re proud to share this powerful reflection from Garry Brough, Programme Manager at Fast-Track Cities London and a long-standing advocate for peer support in HIV care. Garry brings both personal insight and professional expertise to the conversation around what meaningful support truly looks like for people living with HIV.
While peer support has long been recognised as a useful tool in helping people to live well with HIV, there has been a tendency to consider it as a ‘nice-to-have’ option, rather than an essential component of whole-person care. Research has demonstrated its effectiveness in supporting self-management strategies and improving engagement with treatment and care, but its integration within the NHS has been slow.
Early innovation: bringing support to the clinic
The Lawson Unit in Brighton was the first HIV service to recruit a dedicated volunteer in 2000, with London’s Bloomsbury Clinic employing the first paid in-house HIV peer support worker in 2004. These initiatives recognised that HIV-related stigma made many people fearful of accessing voluntary sector support, so they brought the support to the patient instead.
This approach was embraced by HIV charity Positively UK, who initiated peer support outreach across several London clinics, including peer navigator integration within Homerton Hospital in 2014. Their Project 100 national peer mentor training programme and 2017 National Standards for Peer Support in HIV further validated peer support as a legitimate self-management approach, resulting in clinics across the country bringing in peer support workers and volunteers.
From recognition to integration: embedding peer support in HIV care
The British HIV Association’s 2018 Standards of Care for People Living with HIV referenced the Peer Support Standards and included a specific section on Self-management and Peer Support, with auditable outcomes for agreed pathways to peer support (whether in-house or via external agencies).
With integrated peer support being seen as the gold standard by people living with HIV, it is unsurprising that in London’s Fast-Track Cities 2021 report Evolving the care of people living with HIV in London (developed by Clinical and Community Advisory Groups), Priority 8 of 13 was to Embed peer support in the HIV pathway.
For Fast-Track Cities London’s first Improvement Collaborative in 2020, HIV charities Metro, Positive East and Positively UK used quality improvement methodology to pilot integration approaches in SE, NE and NW London respectively. Their 3-year projects took different approaches to quantify the benefits of in-house peer support workers to patients and services.
Measurable impact: across London clinics
- Metro piloted a re-engagement in care approach, supporting >100 people with complex needs. 85% achieved an undetectable viral load and 60% were referred to additional support. An additional 200+ voluntary sector referrals were made due to peer worker presence in the clinic and multi-disciplinary team meetings.
- Positive East undertook peer-delivered needs assessments, supporting >480 people, a 68% increase in referrals to crucial services. Financial outcomes improved for 69%, housing outcomes improved for 35% and 60% received additional emotional support.
- Positively UK implemented in-clinic email referral pathways, increasing clinician referrals twelvefold. >287 people were supported, with 66% referred into additional support. Shifting from opt-in clinician-offered support referrals for newly diagnosed patients to an opt-out peer support worker call in the first week of diagnosis increased uptake from 11% to 67%.
Given these results, Fast-Track Cities London commissioned the Getting to Zero Programme in 2023, with the aims of embedding peer support workers in every London clinic, re-engaging people lost to care and taking a social prescribing approach to linking people to voluntary sector advice and support services to address non-clinical needs and improve quality of life.
Progress and barriers: what’s working
At 18 months into the two-year programme, peer support is integrated within 25 of 26 London HIV clinics. 22 services include peer support workers in multidisciplinary team meetings and have them log their interventions within the electronic patient records, so that clinicians are aware of the additional information patients share with peers, along with the support they have received.
A standardised wellbeing assessment was developed to assess unmet needs and although barriers and blocks with NHS digital and GDPR have slowed its implementation, we are at last measuring need and progress across the city.
Moving to opt-out newly diagnosed referrals has been slower, as the shift from ‘would you like to speak to a peer support worker’ to ‘our peer support worker will give you a call’ has proved surprisingly difficult to standardise. Only half of the clinics have fully adopted this approach, meaning that a majority of patients still do not receive immediate access to peer support at the most critical time, resulting in unnecessary isolation and anxiety about what it actually means to live with HIV in practical terms.
Looking ahead: peer support as a model for whole-person care
We hope to have fully achieved all our aims by July 2026, to provide a template for how other clinics across the country might best be able to implement this, given that the Getting on Track report mandated that the new HIV Action Plan should provide ‘a national guarantee of peer support through every clinic in England’. This approach will clearly be relevant for managing other long-term conditions and health inequalities, as a lived-experience social prescribing model can ensure that unmet needs are supported in the community.
Looking to our upcoming programmes, peer support workers will be key in addressing internalised stigma and re-engaging people who have dropped out of care and treatment. They will be best placed to have those initial conversations to help move people out of fear and isolation and into the community support offered by voluntary sector partners. We will not get to zero without them and the empathy and reassurance they bring to their peers!
In summary: what we’ve learnt
Our programmes show that peer support is vital to improving quality of life and keeping people in care and on medication, by:
- Embedding trained, professional and well-supported peer workers within the HIV clinic team.
- Making peer support ‘opt-out’ so everyone receives it routinely as part of their care.
- Linking people to voluntary sector advice and support services to address wider determinants of health
This World AIDS Day, Fast-Track Cities London reaffirms its commitment to embedding peer support in every HIV clinic across London – not just as policy, but as practice. Because getting to zero new HIV infections, zero stigma and discrimination, and zero AIDS-related deaths depends on meeting people where they are, with empathy, understanding and support.
Peer support isn’t optional. It’s vital.