Sometimes the most revealing decisions in public health come down to a single word.
Across the country, addiction recovery programs openly hire Peer Recovery Coaches and Peer Support Specialists, recognizing that lived experience is a powerful tool in helping others navigate recovery. Yet in some HIV programs, similar roles appear under more neutral titles such as Linkage to Care Specialist or Treatment Adherence Specialist.
The work may look similar. The message to the community is not.
The concept of peer support did not originate in HIV programs.
Modern peer roles trace their roots to the psychiatric survivor and mental health consumer movements of the 1970s and 1980s, when people with lived experience of mental illness began supporting one another outside traditional clinical systems. Those efforts later became formalized as Peer Support Specialists within behavioral health systems.
The model expanded further in addiction recovery, where Peer Recovery Coaches and Recovery Support Specialists are now widely recognized roles built on lived experience with substance use and recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes peer support as an evidence-based component of behavioral health systems.
Only more recently has the model been adopted in HIV care. Peer navigators and peer educators have been shown to improve engagement in care, treatment adherence, and retention among people living with HIV. The Health Resources and Services Administration (HRSA), which oversees the Ryan White HIV/AIDS Program, has highlighted peer navigation as a promising strategy for strengthening the HIV care continuum.
That history matters because peer support was never simply a staffing model. It was a philosophy that recognized lived experience as a form of expertise.
What distinguishes peer roles is not just the tasks they perform, but the intentional use of lived experience as part of the intervention itself.
That is why language matters.
In addiction recovery programs across the country, the word peer appears openly in job titles. Yet in some HIV programs, similar roles are introduced under more neutral titles that existed long before peer navigation models were adopted.
The explanation often offered is practical. Human resources departments sometimes worry that including the word peer could imply hiring based on HIV status.
But other fields have already found ways to recognize lived experience while still operating within standard hiring frameworks, often through training and certification models.
If addiction recovery systems can openly recognize lived experience in job titles, it raises a fair question: why does HIV work sometimes hesitate to do the same?
Part of the answer may be institutional culture. Large organizations often gravitate toward language that feels more neutral or professionalized.
Part of it may also reflect something more specific to our region. HIV stigma still runs deep in many Midwestern communities. Even as treatment has transformed HIV into a manageable condition, the social discomfort around the virus has not disappeared.
As HIV navigation programs continue to grow in Indianapolis, this may be a moment to revisit whether our language reflects the full spirit of the peer movement.
Sometimes a single word tells people whether their lived experience is being welcomed into the system, or quietly edited out of it.
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