Patients to Peer Mentors: Youth Leading the Way in HIV Resilience & Stigma Reduction

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Denison, J. A., Burke, V. M., Miti, S., Nonyane, B. A. S., Frimpong, C., Merrill, K. G., Abrams, E. A., & Mwansa, J. K. (2020). Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15–24 years) in Ndola, Zambia. PLOS ONE, 15(4), e0230703. https://doi.org/10.1371/journal.pone.0230703

Introduction

Youth living with HIV in sub-Saharan Africa experience poorer treatment adherence and viral suppression than adults. To address this disparity, Project YES! was developed to test whether paid, HIV-positive youth peer mentors could improve health outcomes, including adherence, viral suppression, and stigma reduction among 15–24-year-olds attending HIV clinics in Ndola, Zambia. This program offers insight into a universally relevant issue: the role of peer support in reducing internalized stigma and promoting engagement in care.

Methods

A randomized controlled trial enrolled 273 youth across four clinics, randomly assigning participants to either standard care or the Project YES! intervention. The intervention offered monthly one-on-one and group mentoring sessions led by trained peer mentors, alongside optional caregiver meetings. Outcomes included viral suppression (VS), antiretroviral therapy (ART) adherence, and internalized stigma, assessed at baseline and six months.

Results

Both groups improved in VS, but the greatest gains occurred among youth in the pediatric clinic, where the odds of VS increased nearly fivefold compared with controls. Internalized stigma significantly decreased in the intervention group (from 50% to 25%), while ART adherence improved modestly. Peer mentoring proved feasible and well received, with 92% of participants completing the intervention.

Discussion

Findings demonstrate that youth-led mentorship can meaningfully reduce stigma and enhance viral suppression, especially in pediatric settings. Empowering HIV-positive youth as paid mentors transformed them into credible role models and strengthened clinic engagement.

Implications for Mentoring Programs

Programs supporting youth with chronic illnesses can adapt Project YES!’s model—training peers to provide structured, empathetic, and ongoing mentorship—to foster self-efficacy, adherence, and resilience.

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