To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections.
A two-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling.
St. Petersburg, Russia and Budapest, Hungary.
Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size?=?35 members, n?=?626) were recruited.
Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members.
Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes.
There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P?=?0.04); UAI with a nonmain partner (P?=?0.04); and UAI with multiple partners (P?=?0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P?=?0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P?=?0.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks.
Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.
HIV prevention, by intervening within social networks, is potentially important but highly understudied. Approaches that systematically identify, train, and enlist known social influence leaders to advise members of their own networks in risk reduction constitute ways to reach hidden population segments, persons who are distrustful of authorities but trust their peers, and those who cannot be reached through traditional professionally delivered counseling. This article illustrates and provides evaluation data on a program that recruited 14 intact social networks of young men who have sex with men (YMSM) in St. Petersburg, Russia, and Sofia, Bulgaria. Sociometric measures were used to identify the social leader of each network, and baseline risk assessment measures were administered to all members of each social network. The sociometrically determined leaders then attended a six-session group program that provided training and guidance in how to carry out theory-based and tailored HIV prevention conversations with members of their own social networks. Four months after leaders completed the program, all network members were readministered risk assessment measures. Pre- to postintervention data revealed that the program produced: (1) increases in the level and comfort with which network members talked about AIDS prevention topics in their daily conversations; (2) increased network-level AIDS risk reduction knowledge and improved risk reduction norm perceptions, attitudes, behavioral intentions, and self-efficacy; and (3) increased condom use levels among network members. Although not a controlled, randomized trial, these program evaluation findings strongly support the feasibility of social network-level HIV prevention approaches.
This study recruited four sociocentric networks (n = 156) of men who have sex with men in Budapest, Hungary, and St. Petersburg, Russia. The sampling approach was based on identifying an initial "seed" in the community for each network, and then recruiting three successive friendship group waves out from the seed. HIV prevalence in the networks was 9%, and the composite rate of other sexually transmitted diseases was 6%. 57% of participants reported both main and casual male partners, and two thirds reported unprotected anal intercourse in the past 3 months. Fifty-five percent of men's most recent anal intercourse acts were with nonexclusive partners, and 56% of most recent anal intercourse acts were unprotected. Sexual risk predictors were generally consistent with behavioral science theory. In addition, risk was associated with more often talking with friends about AIDS, higher ecstasy use, and less often drinking. Sociocentric social network sampling approaches are feasible and constitute a modality for reaching hidden high-risk populations inaccessible through conventional methods.
Cites: Health Psychol. 2003 Jul;22(4):332-912940388
Cites: AIDS Educ Prev. 2003 Jun;15(3):205-2012866833
Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants' HIV vulnerability. Male labor migrants in St. Petersburg (n = 499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas.
The number of new HIV infections in Russia has doubled annually since 1996. A total of 232 424 HIV infections have been officially recorded but the actual number probably exceeds one million. Very little is known about the social, psychological, behavioral, and health care service access of persons living with HIV in Russia.
A cross-sectional sample of 470 persons with HIV/AIDS recruited in 2002 using a representative sampling plan in major St. Petersburg HIV care and service agencies.
Participants completed anonymous self-administered questionnaires that elicited detailed information about social and psychological characteristics, HIV serostatus disclosure and discrimination experiences, and risk practices since learning of their HIV positive status.
Most participants were young (mean age, 25.3 years), knew of their HIV positive status for about 2 years, and had histories of injecting drug use as well as sexual risk behavior. A large proportion reported encountering discrimination including being forced to sign documents acknowledging their HIV status (47.9%), refusal of general health care (29.6%), being fired from their jobs (9.9%), and being forced from their family homes (9.0%). Over one-third had probable clinical depression. Most remained sexually active since learning of their HIV positive serostatus, approximately half engaged in unprotected sex with HIV negative partners, and condoms were not used one-third of the time with discordant partners. A majority of injecting drug users in the sample still shared needles.
HIV-infected persons in Russia experience a wide range of social, psychological, and care access problems. Improved services are urgently needed for persons living with HIV/AIDS in Russia.
To evaluate the effects of an HIV prevention intervention with social networks of young men who have sex with men (YMSM) in St. Petersburg, Russia and Sofia, Bulgaria.
A two-arm randomized trial with a longitudinally-followed community cohort.
Fifty-two MSM social networks were recruited through access points in high-risk community venues. Network members (n = 276) were assessed to determine risk characteristics, administered sociometric measures to empirically identify the social leader of each network, and counseled in risk reduction. The leaders of 25 experimental condition networks attended a nine-session program that provided training and guidance in delivering ongoing theory-based HIV prevention advice to other network members. Leaders successively targeted network members' AIDS risk-related knowledge and risk reduction norms, attitudes, intentions, and self-efficacy. Participants were re-administered risk assessment measures at 3- and 12-month follow-ups.
Among changes produced, the percentage of experimental network members reporting unprotected intercourse (UI) declined from 71.8 to 48.4% at 3-month follow up (P = 0.0001). The percentage who engaged in UI with multiple partners reduced from 31.5 to 12.9% (P = 0.02). After 12 months, the effects became attenuated but remained among participants who had multiple recent sexual partners, the most vulnerable group. Little change was found in control group networks.
Interventions that engage the identified influence leaders of at-risk YMSM social networks to communicate theory-based counseling and advice can produce significant sexual risk behavior change. This model is culturally pertinent for HIV prevention efforts in former socialist countries, as well as elsewhere for other hard-to-reach vulnerable community populations.