Peer Facilitation as a Methodological Condition: What Participatory Photovoice Revealed About Transition to Adulthood Among Youth Living with HIV in India

Transition readiness instruments for youth living with HIV were developed in high-income settings and define readiness as clinical competence and individual autonomy. Few reflect youth in low- and middle-income settings, where family obligation and community stigma shape the passage to adulthood. In March 2026, sixteen youth living with HIV aged 13-22 years took part in a peer-facilitated photovoice study at two sites in Karnataka, India: Bengaluru and Belgaum. Participants photographed and collectively interpreted their experiences of growing up and their expectations of the future. Six returned in May 2026 for a reflective discussion of the method. Participants defined independence as the capacity to sustain others, located the principal risks of transition in relational and social rather than clinical domains, and recommended that transition preparation begin around age twelve. Reciprocal obligation was absent from the initial codebook and emerged through participants’ visual metaphors. Peer facilitation was a condition of the inquiry rather than an enhancement of it, and photovoice reporting should specify who exercised interpretive authority. Participatory photovoice can broaden prevailing definitions of transition readiness and inform more youth-responsive assessments.