A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users.
OBJECTIVE
To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU).


METHODS
We conducted a randomized controlled trial involving HIV and HCV antibody-negative IDU, aged 15-30 years, recruited in five United States cities. A six-session, small-group, cognitive behavioral, skills-building intervention in which participants were taught peer education skills (n = 431) was compared with a time-equivalent attention control (n = 423). Baseline visits included interviews for sociodemographic, psychosocial, and behavioral factors during the previous 3 months; HIV and HCV antibody testing; and pre/posttest counselling. Procedures were repeated 3 and 6 months postintervention.


RESULTS
The intervention produced a 29% greater decline in overall injection risk 6 months postintervention relative to the control [proportional odds ratio 0.71; 95% confidence limit (CL) 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-years) did not differ significantly across trial arms (relative risk 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed.


CONCLUSIONS
Interventions providing information, enhancing risk-reduction skills, and motivating behavior change through peer education training can reduce injection risk behaviors, although risk elimination might be necessary to prevent HCV transmission.
Garfein
Richard S
RS
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. rgarfein@ucsd.edu
Golub
Elizabeth T
ET
Greenberg
Alan E
AE
Hagan
Holly
H
Hanson
Debra L
DL
Hudson
Sharon M
SM
Kapadia
Farzana
F
Latka
Mary H
MH
Ouellet
Lawrence J
LJ
Purcell
David W
DW
Strathdee
Steffanie A
SA
Thiede
Hanne
H
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006266:Health Education / Q000379:methods*; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D010379:Peer Group; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology