Jackie Howell talks about what it’s like to be a peer

Jackie Howell is a 54-year-old widow with one son and two granddaughters, ages 5 and 10. She enjoys interior design, dancing, bowling, and the company of good friends. Jackie began her advocacy work for people living with HIV in 1998 by providing sensitivity training for medical staff at Montefiore Hospital in New York. She attended training at Harlem Hospital in 2000 and has worked as a peer educator in the Harlem Hospital Infectious Diseases Division for seven years.

You have to let the client know that you are like them, that you have gone through these things before and that if you can go through it, they can go through it. And you will go through it with them.

During this time, Jackie has helped dozens of clients through the daily challenges of living with HIV/AIDS. In addition, this spring she used the skills that she has developed in the Harlem Hospital program to co-facilitate training sessions for new peers at PACT (Peer Advanced Competency Training Project), a New York-based national education and capacity-building center for peer programs. Jackie recently shared with us her reflections on what it’s like to be a peer.

Connecting with the client

The most important thing you do as a peer is to connect with the client. Unless you build trust, the client is not going to speak to you or believe what you say. You let the client know that you are their support, that they can call you. You have to let the client know that you are like them, that you have gone through these things before and that if you can go through it, they can go through it. And you will go through it with them.

I try to find ways to connect with a client. I had one client who loved baseball and football. I’m not into sports, but one thing I did know about was Muhammad Ali. He and I connected just based on that one conversation.

A lot of times a client has built a wall and will just not let you break it down. One young girl came to us from pediatrics. She felt that we were old, and she did not want to connect with us at all. I called her many times; she would not accept my calls. I tried to find something that would connect us. Many weeks went by and I kept calling and leaving messages. Finally she came to one of the support groups, and I sat down with her and let her know I was there for her. We started talking about being female, and she identified with me on that level. And we became friends.

For a while, I called her to remind her to take her medication, until she became adherent on her own. We have all kinds of reminder tools—beepers and timers—but I guess she just needed that call from me. She went from not wanting to talk to anyone to where she decided that she wanted to be a peer. There is a youth peer program starting up, for ages 16 – 25, and she wants to be a peer for that program.

What the peer does

I work about 10 hours a week. We talk with clients about how they are doing with their medications, if they have any questions about their treatment or if there was anything that would upset their adherence to the medication. You always put the ball in the client’s court, so you’re not telling them what to do, you’re asking them what they would like to do. If the client said the issue was drugs, then you would ask them ‘What would you like to do about your drug problem?’ If the client said ‘I want some help with my addiction’, then you would make a referral to the case manager.

We help to navigate the system with them. You let them know that whatever obstacles they need to go through, whatever they feel fearful of, you can go through it with them. I had a client who didn’t like the dentist. I don’t either, but when she asked ‘Would you go with me?’ I went. She got through it, and then she started going to the dentist on her own and I didn’t have to go with her any more.

The doctors are very respectful of the peers at Harlem Hospital. They look at peers as people who are doing a job, and that’s helped the peer program succeed.

We have a support group every Wednesday for two hours. Sometimes I would lead the support group; sometimes we had guests come in. We have also gone to Community Advisory Board meetings at the hospital. We have gone to conferences, too—I presented once on the peer program at a conference in Mississippi.

Part of the care team

Every other week we had case management meetings where the social workers, the peers, the case managers, and the head doctor sat down and talked over each client–their adherence, issues they were having, how they were doing. It’s exciting to know all the components of the hospital and to be connected through the program and through our clients.

The doctors are very respectful of the peers at Harlem Hospital. They look at peers as people who are doing a job, and that’s helped the peer program succeed.

The rewards of being a peer

I like seeing the client come in and reach a different level when they leave. The clients looked at the peers and saw how they lived—that they stopped using drugs, they were working, they were taking their medication. They saw how much better the peers were getting, and they would say ‘I want to be like that,’ and they would start taking their medication. I saw many clients connect really well with their peers and start taking care of themselves and making their doctor appointments and looking forward to their group meetings.

Can you imagine a client who didn’t want to know anything about HIV, didn’t want to know anything about getting off drugs, about taking care of themselves in the end wanting to do all these things? So our clients became adherent for the most part and the T-cells started increasing and the viral loads started decreasing, and that was our success.