Meet the Teams

Written by: Julianah Adebisi and Miracle Adesina | IMPACT Team, Nigeria.

We didn’t notice it at first, but something had changed.

Just weeks earlier, Zainab had become a major driving force behind HIV outreach in the camp. Young people were showing up to discussions. Her peers listened, showed up, and stayed engaged.

“Zainab” engaging her peers during an HIV outreach session in the camp. Peer trust is often the foundation of youth health programs.

There was energy, the kind you hope for when working with peer-led models.

Then, a personal conflict disrupted those relationships, and with it, the flow of new participants into the program.

Our most successful outreach channel had slowed to a halt.

That moment made us rethink what we thought we understood about peer-led models, especially in displacement settings.

Why we chose a peer-led approach

Young people often learn about sex, relationships, and risk from their peers long before they encounter formal health services. Peer-led outreach taps into these existing social networks. The logic is simple, versatile, and compelling: young people trust their peers, understand each other’s realities, and communicate information in ways that feel relatable.

For the Innovative Mobilization and Participatory Action for Community Transformation (IMPACT) project, this approach felt especially appropriate as we worked with young people living in Internally Displaced Persons (IDP) camps in Nigeria.

We trained a small group of youth champions and encouraged them to reach out to peers in their own social circles: friends, neighbours, and classmates at camp. It was a snowball approach. Each young person could bring others.

It seemed to work; we were gaining momentum.

Where we hit a wall

One champion stood out. Zainab was motivated, well-respected, and committed to the project. Through her efforts, we saw a noticeable increase in participation. Her peers listened to her. They showed up. Momentum began to build.

Without realizing it, we began to rely heavily on her network.

So, when conflict emerged from within her circle, the impact rippled outward. She stepped back from active recruitment. The peers she had mobilized became less engaged. New participants stopped coming.

At first, it felt like a setback. We had invested in training. We had seen progress, and now the progress was slowing.

However, with reflection, we realized that this wasn’t a failure of Zainab or her peers.

It was a gap in our project design.

What this taught us about peer networks

Peer-led models often assume that social networks are stable. In some communities, that may be true. However, in IDP camps, relationships live under constant strain.

Young people are navigating economic stress, family trauma, uncertainty about the future and competition for limited resources. These pressures do not stay outside the room when we hold HIV sessions; they affect how young people relate to each other.

In that environment, small disagreements can grow quickly.

Emotional strain is high, and when leadership is concentrated in one person, a single strained relationship can stall momentum.

What slowed our outreach was not resistance to HIV education. It was the fragility of relationships in a high-stress setting.

An illustration of shared leadership in youth outreach. Programs are strongest when responsibility is distributed.

An illustration of shared leadership in youth outreach. Programs are strongest when responsibility is distributed.

Rethinking how we support youth champions

The situation compelled us to reassess our support for young people who assume leadership roles in health programs.

Being a youth champion is more than delivering information; it means managing friendships, expectations, and sometimes tension, all while mobilizing others.

From this experience, we learned that peer-led models work better when leadership is distributed, rather than concentrated. Recruiting champions in clusters makes the program less vulnerable to the ups and downs of a single relationship.

We also learned that conflict is not a disruption to community work but a part of it. Creating space for early conversations, mentorship, and mediation matters more than we initially realized.

Designing youth health programs for real-life complexity

In displacement settings, health education competes with urgent daily needs influenced by economic pressure, emotional stress, and unstable social relationships, all of which affect how young people engage with HIV prevention.

Peer-led approaches need to be designed with flexibility and empathy, recognizing that health is only one part of what young people are dealing with every day.

Our experience reminded us that effective youth health programming in humanitarian contexts requires careful design, including:

• Avoiding over-reliance on one champion
• Investing in supporting relationships, not just training
• Linking HIV outreach with livelihood support, psychosocial services, and other programs that respond to young people’s everyday realities

Moving forward

The setback in our recruitment was not the end of the story.

It pushed us to distribute leadership more intentionally, to check in more frequently with our youth champions, and to treat relational dynamics as part of program design.

Peer power remains one of the strongest tools in youth HIV prevention.

However, these peer-led models are only as strong as the relationships that sustain them.

Youth champions and participants during outreach. Peer power continues, strengthened by shared responsibility.

Written by: Damilola Ayowole, Temitope Oluwadare, Soneye Islamiat & Azees Ayotunde | Team Abeokuta, Nigeria

We have spent years working with numbers, prevalence rates, treatment coverage, viral suppression targets. Data shapes how we understand HIV, how we design programs, and how we measure success. Yet, during the designathon that birthed HIV-In-Colors, we confronted a difficult truth: data alone does not tell the full story of adolescents and young people living with HIV.

That realization became both the greatest challenge and the most important lesson of this project.

The challenge: when evidence feels incomplete

As public health physicians, we are trained to trust evidence. Surveys, indicators, and clinical outcomes guide our decisions. But as we began designing HIV-In-Colors, we felt an uncomfortable gap between what the data said and what young people actually lived.

The numbers told us that adolescents were on treatment. They did not tell us how it felt to hide medication from friends, to fear disclosure at school, or to internalize stigma long after a clinic visit ended. The data showed retention rates; it did not show shame, silence, or resilience.

At the designathon, our initial instinct was to “strengthen psychosocial support” in familiar ways, add counseling sessions, integrate screening tools, train providers. These ideas were evidence-based, but they were also top-down. We were designing for young people, not with them.

That was our first major challenge: unlearning professional certainty.

Learning to listen differently

The designathon forced us to slow down and listen, not through questionnaires, but through stories. Conversations with fellow participants, mentors, and youth advocates pushed us to ask a different question: What if young people could show us their experiences instead of explaining them?

That question reshaped the project.

Photovoice emerged not simply as a research method, but as a listening tool we needed to learn. The idea that adolescents could use images to document stigma, hope, isolation, or healing shifted the balance of power. Instead of extracting information, we created space for expression.

This approach challenged us deeply. As researchers, we value structure, defined tools, measurable outcomes, clear endpoints. Photovoice resists rigidity. It is emotional, unpredictable, and deeply personal. It demanded trust: trust in participants, trust in the process, and trust that meaning could emerge without being forced.

The designathon lesson: Youth are not just beneficiaries

One of the most powerful lessons from the designathon was realizing that youth expertise is not symbolic, it is practical. When adolescents and young people living with HIV became central to the design conversation, the intervention evolved in ways we had not anticipated.

Healing circles, for example, were initially framed as group therapy sessions. Youth feedback transformed them into something broader: safe, recurring spaces for shared silence, laughter, anger, and belonging. The emphasis shifted from “intervention delivery” to community formation.

We learned that stigma is not only external. Many young people spoke about stigma they had absorbed into their self-identity. No survey captured that adequately. Their stories did.

Listening also revealed constraints we might otherwise have overlooked, fear of being photographed, concerns about confidentiality, emotional fatigue. These realities shaped our ethical safeguards and implementation strategies far more effectively than any protocol draft.

When impact is not immediately measurable

Another challenge was resisting the urge to define success too narrowly. In public health, we often prioritize quick wins and easily measurable outcomes. But psychosocial healing does not follow linear timelines.

Some lessons from HIV-In-Colors were subtle: a participant speaking for the first time in a group, someone choosing a metaphor instead of words, another deciding not to share an image publicly, and feeling empowered by that choice.

The designathon helped us recognize that process itself can be impact. Creating a safe space is not a precursor to intervention; it is the intervention.

This reframing was uncomfortable. It required us to accept outcomes that are harder to quantify but no less real.

What we will carry forward

Looking back, the most important lesson from HIV-In-Colors is this: programs fail when we confuse participation with inclusion. Inviting youth to attend sessions is not the same as inviting them to shape meaning.

Listening requires surrender of expertise, of timelines, of control. But it also creates interventions that breathe, adapt, and endure.

The designathon strengthened our belief that innovation in HIV care does not always mean new technology or complex systems. Sometimes, it means creating space for young people to be seen, heard, and trusted as narrators of their own lives.

As we move forward with this project and others, we carry a quieter confidence. We still value data deeply, but we now ask different questions of it. We look for the stories it misses and the voices it cannot capture.

Because when it comes to adolescents and young people living with HIV, listening is not optional, it is the work.