Amirkhanian Yuri A, Kelly Jeffrey A, Kabakchieva Elena, Kirsanova Anna V, Vassileva Sylvia, Takacs Judit, DiFranceisco Wayne J, McAuliffe Timothy L, Khoursine Roman A, Mocsonaki Laszlo
Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA.
AIDS. 2005 Nov 4;19(16):1897-905. doi: 10.1097/01.aids.0000189867.74806.fb.
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.
评估在俄罗斯圣彼得堡和保加利亚索非亚针对与男性发生性关系的年轻男性（YMSM）社交网络开展的艾滋病预防干预措施的效果。
一项双臂随机试验，采用纵向跟踪社区队列。
通过高危社区场所的接入点招募了52个男男性行为者社交网络。对网络成员（n = 276）进行评估以确定风险特征，采用社会测量方法从经验上确定每个网络的社交领袖，并提供降低风险的咨询。25个实验组网络的领袖参加了一个为期九节的项目，该项目提供培训和指导，以便向其他网络成员提供持续的基于理论的艾滋病预防建议。领袖们依次针对网络成员与艾滋病风险相关的知识以及降低风险的规范、态度、意图和自我效能。在3个月和12个月的随访中对参与者重新进行风险评估测量。
在产生的变化中，报告无保护性行为（UI）的实验组网络成员百分比在3个月随访时从71.8%降至48.4%（P = 0.0001）。与多个性伴侣发生无保护性行为的百分比从31.5%降至12.9%（P = 0.02）。12个月后，效果有所减弱，但在近期有多个性伴侣的参与者（最脆弱的群体）中仍然存在。对照组网络中几乎没有发现变化。
让处于风险中的男男性行为者社交网络中确定的有影响力的领袖进行基于理论的咨询和建议交流的干预措施，可以显著改变性风险行为。这种模式在文化上与前社会主义国家的艾滋病预防工作相关，在其他地方对其他难以接触到的脆弱社区人群也适用。
