Voice, influence and belonging: HIV community health workers' lived experience on the interdisciplinary health team

ABSTRACT

The integration of Community Health Workers (CHWs) on HIV healthcare teams has been endorsed as a way to mitigate social determinants associated with poor health outcomes and, through the power of shared identity, engage persons living with HIV into care who have been harmed by stigma and racism. This phenomenological study was conducted to explore factors that constrain or facilitate meaningful integration of HIV CHWs within healthcare organizations. In individual interviews, ten CHWs employed by New York City HIV healthcare providers discussed their lived experience on the team. Several major themes in their lived experience emerged. First, a sense of mutual reliance on the team inspired CHWs, but created vulnerability to disillusionment and anxiety when the health system failed to live up to its promise. Second, failed communication between CHWs and other team members interfered with client care. Third, strong supervision grounded CHWs as they worked in the field. Fourth, duplicative documentation distracted from CHW focus on client care. Fifth, CHWs enhanced their voice and credibility on the team through developing deep understanding of their clients' concerns. Sixth, CHWs felt inadequate to address deep-rooted social problems such as lack of safe permanent housing and chronic addiction. Finally, CHWs reported that they used creativity and perseverance to overcome fear generated by the risks and disruption of the COVID-19 pandemic. Participants in this study vividly expressed their desire for improved communication across professional hierarchies. Practice and research implications include the importance of developing initiatives to examine the best methods to provide team training, role clarity, team communication and evaluation where CHWs are employed on outpatient HIV care teams. CHWs' ability to address social determinants of health depend on their ability to participate in the development of health promotion policy efforts. In the field of HIV services, this should include funding CHWs to work in close partnership with non-medical organizations that provide legal or harm reduction advocacy, while at the same time remaining integrated with outpatient primary care practices. Future research should identify CHW programs where staff are charged with community organizing and HIV policy advocacy, and identify key outcomes such as permanent housing status. (PsycInfo Database Record (c) 2022 APA, all rights reserved)