Effects of a social network HIV/STD prevention intervention for MSM in Russia and Hungary: a randomized controlled trial.

OBJECTIVE

To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections.

DESIGN

A two-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling.

SETTING

St. Petersburg, Russia and Budapest, Hungary.

PARTICIPANTS

Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size = 35 members, n = 626) were recruited.

INTERVENTION

Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members.

MAIN OUTCOME AND MEASURES

Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes.

RESULTS

There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P = 0.04); UAI with a nonmain partner (P = 0.04); and UAI with multiple partners (P = 0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P = 0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P = 0.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks.

CONCLUSION

Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.