Peer Support and retention in HIV care for sub-Saharan African and Caribbean migrant women: The Positive Sisters program in the Netherlands

Retention in HIV care is a crucial element in the effectiveness of HIV treatment and care strategies. Barriers to care exist for various key populations such as sub- Saharan African migrants in developed countries. Peer support has become an essential component in bridging the gap between formal health care services and barriers to HIV care. This research paper studies the role of the Positive Sisters peer support program in the Netherlands that focuses on migrant women from sub-Saharan Africa and the Caribbean, in retention in HIV care. The study explores the behavioural processes that influence decision making of participants towards retention and adherence outcomes and how the program interacts with these processes. The study employs a behavioural economics framework and a qualitative approach through semi-structured interviews with 30 program participants and 2 key informants. The findings suggest that despite diminishing utility to program consumption, the positive sisters program helps retain women in HIV care through a process of various elements. Three behavioural processes that threaten retention to care and adherence outcomes were identified; selfcontrol, time inconsistency and mental models. In addition, the program is aware of the behavioural processes and the barriers to care for this key population. However, lack of adequate financial funding remains a barrier to scaling up the program and introducing new activities for program participants. Moreover, the findings of this study remain suggestive due to self-selection bias from program entry and lack of a control group to compare outcomes.