Abstract
Despite advances in antiretroviral therapy (ART), HIV remains a significant public health challenge worldwide, particularly in Latin America, where stigma, mental health needs, and social inequities persist. In Chile, although the national HIV law mandates state responsibility for treatment and prevention, structured peer-led strategies for people living with HIV (PLHIV) have not yet been widely integrated into health services, and local evidence on their impact is limited. This Practice Note reviews recent global research on peer support interventions to identify lessons relevant for designing culturally sensitive and sustainable programs in Chile. International studies demonstrate that peer support can improve ART adherence, mental health, social connectedness, and health-related quality of life (HRQOL). However, effective implementation requires careful cultural adaptation, structured training, sustainable funding, and integration into health care systems. Establishing peer support as a core element of HIV care could align with Chile’s legal obligations and be incorporated as a minimum competency within hospital and primary care teams. Moreover, life-history research in Latin America is urgently needed to illuminate local experiences and social dynamics that shape the acceptability and effectiveness of peer-led approaches. Practitioners and policymakers should recognize peer support not merely as an optional adjunct but as an essential strategy to humanize HIV care, promote holistic well-being, and help achieve national and global HIV goals. The time has come to translate global evidence into locally meaningful action to ensure that PLHIV in Chile receive comprehensive, person-centered care.
Biomedical advances have transformed HIV into a chronic condition, significantly reducing mortality and extending life expectancy for millions worldwide. Yet HIV remains a major public health concern, with over 39 million people living with the virus and 1.3 million new infections reported in 2022. Beyond viral suppression, improving health-related quality of life (HRQOL) has become essential due to ongoing challenges such as mental health issues, stigma, and social isolation (Fuster-RuizdeApodaca et al., 2023).
In Chile, HIV care has focused primarily on biomedical outcomes, with limited integration of peer-led strategies into health services. Local evidence on the impact of peer support interventions is scarce, leaving practitioners without clear guidance for implementation. To address this gap, we conducted a focused narrative review of peer-reviewed literature, using search terms related to HIV, peer support, quality of life, and Latin America. Our goal is not to document current practice in Chile, but to extract global lessons that can guide the design of effective, culturally sensitive peer support programs suitable for our local context.
Assessment of Need
Globally, mental health conditions such as depression affect nearly half of PLHIV, strongly influencing ART adherence and HRQOL (Berg et al., 2021). Calderón Silva et al. (2023) conducted a qualitative study in Chile where they interviewed young PLHIV and found that stigma remains a significant barrier, limiting disclosure, social support, and engagement with care services. In Chile, although ART coverage has expanded, psychosocial support services remain insufficient, highlighting an urgent need for innovative approaches such as peer-led interventions, which young people recognize as fundamental to face the process of acceptance of the disease (Calderón Silva et al., 2023).
Description of the Strategy and Intended Outcomes
Peer support involves PLHIV who share personal experiences, provide guidance, and offer emotional support to others navigating similar challenges (Wells et al., 2022). Internationally, peer-led programs have been implemented through group meetings, individual counseling, and increasingly via digital platforms that enhance privacy and extend reach (Dunn Silesky et al., 2025). Peer supporters typically receive training in active listening, mental health awareness, confidentiality, and health system navigation. The power of shared experience fosters trust, reduces isolation, and normalizes living with HIV, enabling open discussions about stigma, treatment adherence, and self-management (Fuster-RuizdeApodaca et al., 2023).
Global studies indicate that peer support improves ART adherence, retention in care, mental health outcomes, and HRQOL for PLHIV (Berg et al., 2021). It also helps reduce internalized stigma and fosters community belonging, aligning with the UNAIDS 95-95-95 targets and the emerging goal that 95% of PLHIV with viral suppression report good quality of life.
Challenges, Successes, and Evaluation Findings
Although peer support demonstrates clear benefits, implementation faces notable challenges. Globally, many programs operate with inconsistent funding and lack dedicated budget allocations within national health plans. Integration into clinical teams can meet resistance from health professionals unfamiliar with peer roles, while cultural sensitivities and confidentiality remain critical issues, especially in smaller communities where privacy can be difficult to maintain. The quality and consistency of training and supervision also vary, influencing program outcomes (Berg et al., 2021).
Nevertheless, successes are significant. Participants often report feeling genuinely understood and supported in ways they do not experience in traditional clinical settings (Wells et al., 2022). Peer support has been linked to reductions in anxiety and depression, greater confidence in managing health, and improved ART adherence (Berg et al., 2021). The shift to digital platforms during the COVID-19 pandemic demonstrated the adaptability of peer support programs, allowing services to maintain or expand reach while protecting privacy (Dunn Silesky et al., 2025).
Evaluations have combined quantitative measures like the WHOQOL-HIV BREF and EuriQol-5D (EQ-5D) to track changes in quality of life, with qualitative methods such as interviews and focus groups revealing personal experiences, program barriers, and facilitators. Although some results vary, many studies confirm the unique emotional and social benefits of peer support interventions. While local data in Chile on peer support is lacking, initial conversations with practitioners and community leaders suggest interest and the perceived need for such interventions.
Implications for Practice
Implementing peer-led strategies in Chile offers a crucial opportunity to enhance psychosocial support and improve HRQOL for PLHIV. Practitioners should prioritize culturally tailored training that addresses local social norms, gender dynamics, and stigma, ensuring interventions are both effective and acceptable. Clear role definitions and ethical guidelines are essential to protect confidentiality and guarantee program sustainability. Collaborations with community organizations can help identify peer supporters who reflect the diverse experiences and cultural backgrounds of PLHIV in Chile. Digital interventions should also be explored to increase privacy, flexibility, and reach, especially in regions where stigma remains pervasive.
However, it is critical not to replicate international models wholesale. Instead, interventions should be co-designed with PLHIV to ensure cultural relevance, linguistic appropriateness, and community ownership. Life-history research in Chile and Latin America is urgently needed to capture local experiences, values, and nuanced challenges. Such research can provide crucial insights to tailor peer-led interventions effectively and ensure they resonate deeply with the lived realities of PLHIV communities, fostering greater trust and engagement.
For instance, training modules could integrate Chilean cultural narratives around family, gender, and social roles to make peer messaging more relatable and impactful. Partnering with existing HIV community organizations, such as Fundación Savia, could facilitate peer recruitment, sustainability, and contextual adaptation. In Chile, peer support represents an untapped opportunity to humanize HIV care, address social determinants, and promote better quality of life. Now is the time to translate global evidence into locally meaningful and transformative action.
Conclusion
Peer support offers a powerful strategy to improve mental health, adherence, and quality of life for people living with HIV. In Chile, where the HIV Law mandates state responsibility for treatment and prevention, integrating peer support as a core component of care aligns with legal obligations and could be established as a minimum competency within hospital and primary care teams. Peer support for PLHIV involves trained individuals sharing experiences and guidance through various platforms to build trust, reduce isolation, and promote open discussions about stigma and health management.
