Kelly Jeffrey A, Amirkhanian Yuri A, Kabakchieva Elena, Vassileva Sylvia, Vassilev Boyan, McAuliffe Timothy L, DiFranceisco Wayne J, Antonova Radostina, Petrova Elena, Khoursine Roman A, Dimitrov Borislav
Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, Wisconsin 53202, USA.
BMJ. 2006 Nov 25;333(7578):1098. doi: 10.1136/bmj.38992.478299.55. Epub 2006 Oct 13.
To determine the effects of a behavioural intervention for prevention of HIV and sexually transmitted diseases that identified, trained, and engaged leaders of Roma (Gypsy) men's social networks to counsel their own network members.
A two arm randomised controlled trial.
A disadvantaged, impoverished Roma settlement in Bulgaria.
286 Roma men from 52 social networks recruited in the community.
At baseline all participants were assessed for HIV risk behaviour, tested and treated for sexually transmitted diseases, counselled in risk reduction, and randomised to intervention or control groups. Network leaders learnt how to counsel their social network members on risk prevention. Networks were followed up three and 12 months after the intervention to determine evidence of risk reduction.
Occurrence of unprotected intercourse during the three months before each assessment.
Reported prevalence of unprotected intercourse in the intervention group fell more than in control group (from 81% and 80%, respectively, at baseline to 65% and 75% at three months and 71% and 86% at 12 months). Changes were more pronounced among men with casual partners. Effects remained strong at long term follow-up, consistent with changes in risk reduction norms in the social network. Other measures of risk reduction corroborated the intervention's effects.
Endorsement and advice on HIV prevention from the leader of a social network produces well maintained change in the reported sexual practices in members of that network. This model has particular relevance for health interventions in populations such as Roma who may be distrustful of outsiders.
Clinical Trials NCT00310973.
确定一种预防艾滋病毒和性传播疾病的行为干预措施的效果，该措施识别、培训并促使罗姆（吉普赛）男性社交网络的领导者为其网络成员提供咨询。
双臂随机对照试验。
保加利亚一个处于不利地位、贫困的罗姆人定居点。
从社区招募的来自52个社交网络的286名罗姆男性。
在基线时，对所有参与者进行艾滋病毒风险行为评估、性传播疾病检测和治疗、风险降低咨询，并随机分为干预组或对照组。网络领导者学习如何就风险预防向其社交网络成员提供咨询。在干预后3个月和12个月对各网络进行随访，以确定风险降低的证据。
每次评估前三个月内无保护性交的发生情况。
干预组报告的无保护性交流行率下降幅度大于对照组（分别从基线时的81%和80%降至3个月时的65%和75%，以及12个月时的71%和86%）。在有临时伴侣的男性中变化更为明显。长期随访时效果依然显著，这与社交网络中风险降低规范的变化一致。其他风险降低指标也证实了干预措施的效果。
社交网络领导者对艾滋病毒预防的认可和建议能使该网络成员报告的性行为产生持续的变化。这种模式对于像罗姆人这样可能对外人不信任的人群的健康干预具有特殊意义。
临床试验NCT00310973。
