title: Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial.
abstract: OBJECTIVE
  A community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out over 2 years in five countries. The main study results did not find significant intervention effects. This paper presents a sub-analysis examining the differential intervention impacts among high-risk and low-risk participants in the China site.
  
  
  METHODS
  From 2002-2006, 3912 migrant market vendors aged 18 and 49 years were recruited at an urban site in China. Markets were randomly assigned to the C-POL intervention (N=20 markets; n=1979) or standard-care control condition (N=20; n=1933). Both study condition venues received HIV/STI education, free condoms, STI testing and treatment, and training for pharmacists in antibiotic treatments. In intervention markets, C-POLs were identified and trained to diffuse messages regarding safer sex, STI treatment and partner discussions of sex. The primary biological outcome was incidence of new STIs (chlamydia, gonorrhoea, syphilis, trichomonas, herpes or HIV). The primary sexual behaviour risk outcome was any unprotected extramarital sex in the prior 3 months.
  
  
  RESULTS
  In unadjusted analyses, women had significantly lower rates of STI infection at 24 months in the C-POL intervention (5.7%) compared to controls (8.3%; p = 0.043). In mixed-effects regression models, intervention participants with STIs at previous assessments were about half as likely to have STIs at 24 months (OR 0.47, 95% CI 0.25 to 0.90) compared to controls.
  
  
  CONCLUSIONS
  The C-POL intervention lowers HIV risk among those at highest risk (i.e., with a STI or engaging in high-risk sexual activities) rather than the general population.
authors.affiliation: University of California, Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024, USA. rotheram@ucla.edu
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Jihui
authors.initials: J
authors.lastname: Guan
authors.forename: Yueping
authors.initials: Y
authors.lastname: Yin
authors.forename: Dallas
authors.initials: D
authors.lastname: Swendeman
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011639:Public Opinion; D021841:Safe Sex; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D014171:Transients and Migrants / Q000706:statistics & numerical data; D047568:Unsafe Sex / Q000517:prevention & control; D055815:Young Adult