A randomized social network HIV prevention trial with young men who have sex with men in Russia and Bulgaria.
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.
Amirkhanian
Yuri A
YA
Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA. yuri@mcw.edu
Kelly
Jeffrey A
JA
Kabakchieva
Elena
E
Kirsanova
Anna V
AV
Vassileva
Sylvia
S
Takacs
Judit
J
DiFranceisco
Wayne J
WJ
McAuliffe
Timothy L
TL
Khoursine
Roman A
RA
Mocsonaki
Laszlo
L
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