Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Social Work


In 2002, the Human Resource Service Administration (HRSA) began encouraging and funding a new strategy in HIV prevention. Referred to as Prevention with Positives (PwP), this approach to HIV prevention focused efforts on intervention with individuals who were already HIV-infected. This study examines one particular modality for the delivery of these important prevention messages to men and women living with HIV - the utilization of a peer-based model. "Peer-based" refers to any program which utilizes HIV-positive individuals as service providers for other HIV-positive individuals. A nationwide sample of such programs is used to provide an exploratory look into the possibilities peer-based programming may hold for PwP interventions.

Semi-structured interviews with various levels of program staff (administrators, supervisors, and peers) were conducted using a mixed methods approach to answer two research questions: 1) To what extent do peer-based models of HIV service delivery adhere to an established set of program characteristics of Prevention with Positives interventions? and 2) What are the experiences of peer-based PwP program staff in terms of implementation and provision of peer-based services? A set of 19 key PwP program characteristics identified in the literature served as a foundation for understanding how peer-based programs fit and/or expanded upon existing traditional PwP strategies.

Findings are discussed in an applied manner, with service providers and funders in mind. Programs participating in the study demonstrate a strong level of fit between the established PwP key program characteristics and the peer-based modality, including several program characteristics which may be better accomplished through the incorporation of peers (e.g. rapport). Advice for other service providers and agencies considering incorporating a peer-based program into their HIV services includes much discussion of additional considerations and commitment to be required (especially related to supervision, recruitment of peers, and management and training needs). However, the overall value peers add to HIV service delivery is found to far exceed the challenges.

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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