University of Virginia Program Uses Peer Coaches to Fight Rural HIV AIDS Stigma


HIV AIDS is treatable but in rural areas the fear of people finding out an individual's HIV status can be a barrier. A University of Virginia Health System team has had success with training peer coaches to counsel such patients.

In small towns the stigma associated with having the HIV virus can be more acute than in big cities. Fear of people finding out their HIV status can keep people in rural America from seeking testing and care.

Reporting at the 20th Annual United States Conference on AIDS in Hollywood, FL, researchers from the University of Virginia Health System outlined a successful approach they have been using in helping people overcome these fears.

Their presentation, made in a poster session at the meeting, was called “Helping Clients Overcome Stigma: A Rural-Based Peer Coach Program.”

Team members included two UV physicians Gregory Townsend MD and Rebecca Dillingham, MD.

The stated objective was to support the health system’s Ryan White patients (those whose care is federally funded under the Ryan White HIV/AIDS program) from a largely rural service to get over their fear of being stigmatized and “build self-management skills.”

It began with a one year pilot program in which volunteer peer coaches were recruited and trained. In the second year the program identified areas for program improvement training and coaches so that the team could reach a diverse group of clients.

Among the topics the coaches discussed with clients were emotional support, social support, the importance of keeping appointments, problems with relationships, and a wide variety of other topics that could be adding stress to clients’ lives.

There were 33 patients in the pilot, most ages 25 to 36.

The team did not quantify its results, but offered case study descriptions that showed how well the approach was working.

One patient, identified as “Ramona” was a 36-year-old Latina who had a major problem dealing with the perceived stigma of disclosing her HIV status. That was causing her great emotional distress and isolations. She also had problems with housing, child support, health insurance and immigration.

The coach over several months worked with Ramona’s community health worker to get her to connect with new people and her own family again.

The team helped her solve her problems, both emotional and practical, and reported she was in a much better mental state and “hopes to build a better future for herself and her daughter.” Part of the coaching involved helping Ramona learn how to solve her own problems and set goals to overcome issues affecting her health and life.

Another case study involved “Jason” a 55-year-old gay African American who was recruited to become a coach. “Though the training provided he learned new tools to help reduce and fight stigma, thus reducing the barriers to care that other peers were experiencing.” He has now been a peer coach, on staff, for two years.

For more information on the program, the contact is Nahuel Smith Becerra at

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