title: A randomized social network HIV prevention trial with young men who have sex with men in Russia and Bulgaria.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A two-arm randomized trial with a longitudinally-followed community cohort.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA. yuri@mcw.edu
authors.forename: Yuri A
authors.initials: YA
authors.lastname: Amirkhanian
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kelly
authors.forename: Elena
authors.initials: E
authors.lastname: Kabakchieva
authors.forename: Anna V
authors.initials: AV
authors.lastname: Kirsanova
authors.forename: Sylvia
authors.initials: S
authors.lastname: Vassileva
authors.forename: Judit
authors.initials: J
authors.lastname: Takacs
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: DiFranceisco
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McAuliffe
authors.forename: Roman A
authors.initials: RA
authors.lastname: Khoursine
authors.forename: Laszlo
authors.initials: L
authors.lastname: Mocsonaki
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002031:Bulgaria; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods; D012307:Risk Factors; D012309:Risk-Taking; D012426:Russia; D012944:Social Support; D047568:Unsafe Sex