The BPAs are paid an hourly fee because they commit more time to work and training than volunteers do; for example, some are "on call" and carry beepers. The BPAs only work part time in order to retain a level of flexibility that full-time staff do not have; they also allow APICHA to hire a broader range of BPAs representing more cultures and languages.

The programme learned several lessons through a focus-group evaluation that may be adapted to a wide range of service contexts in which minority experiences create barriers to service access. The lessons relate to professionalism versus volunteerism, BPA-client relations and translation/interpretation versus client advocacy issues.

Some APICHA case managers felt that the BPAs lack professionalism because they see themselves as volunteers. The BPAs, on the other hand, thought their volunteer spirit is a positive quality that needs to be nurtured. Even small acknowledgements are considered important; as one BPA commented: "I got a birthday card from the Director of Client Services. And on the card at the end, he said, '[David], thank you. You are making a difference.' That meant more to me than the money I make." The case managers did recognize that many BPAs work "with a lot of passion in their heart" but did not associate this with the notion of volunteerism.

Some disagreements occurred regarding the boundaries of BPA-client bonding. Case managers felt that BPAs sometimes became too personally involved with clients, and the peer advocates expressed frustration that case managers may be too rigid or insensitive in enforcing boundaries. Nevertheless, the BPAs did understand the need for boundaries.

Another issue raised in the programme concerned the BPAs' role as interpreters. Case managers felt that they sometimes acted too much as advocates, speaking for clients instead of allowing clients to speak for themselves. The BPAs stressed that it is difficult to interpret strictly given the emotional context of HIV infection and clients' hesitancy in disclosing personal information.

Clients have expressed a high level of satisfaction with the BPA programme. To cope with the internal difficulties mentioned above, some changes will nevertheless be made. Case managers who supervise BPAs will receive more support and training. Whenever possible, BPAs will be permanently assigned to particular clients. The BPAs will receive additional training on client-bonding issues, advocacy and language interpretation. Finally, regular "case conferences" will be held between case managers and their BPA teams so as to cultivate more trust and communication among them.

Lessons learned in APICHA's peer educator and counsellor programme

• When a peer model is newly introduced to an organization, staff may need assistance in learning how to coordinate peer educators or peer counsellors to do the work that they normally would have done themselves.
• Staff may also need to learn new supervision skills. Peer educators and counsellors may be especially hard to supervise because they may not have had previous work experience and may have many other competing demands on their time. If the peers are volunteers, then staff will have to make additional efforts to motivate them and keep them interested in the work.
• Most peer programmes should have dual goals of both providing the needed service to the community and developing the life or job skills of the peer educators and counsellors. Younger peers especially may need a lot of support. This should be built into the programme, e.g., through having a counsellor available and/or running regular support groups for the peers themselves.
• Peers should be evaluated regularly as part of their training and development