Cottler L B, Compton W M, Ben Abdallah A, Cunningham-Williams R, Abram F, Fichtenbaum C, Dotson W
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108, USA.
Public Health Rep. 1998 Jun;113 Suppl 1(Suppl 1):31-41.
The purpose of this chapter is to describe the results of a randomized study (funded by the National Institute on Drug Abuse [NIDA]) comparing a peer-delivered enhanced intervention to the NIDA standard intervention for reducing human immunodeficiency virus (HIV) risk behaviors.
Data come from the ongoing St. Louis Each One Teach One (EOTO) study on HIV risk behaviors among out-of-treatment crack cocaine users and injecting drug users (IDUs). The study has a randomized prospective design, and for this chapter, three risk behaviors were analyzed--the frequency of crack cocaine use and the number of sex partners and condom use over the past 30-day period. We report the level of risk at baseline and at the three-month follow-up period to determine the proportion of individuals improving or worsening based on a dichotomous outcome in which remaining at low risk or decreasing moderate or high risk behaviors is considered "improving" and increasing risk behavior or remaining at moderate or high risk is considered "worsening".
Overall, 80% of the sample "improved" their crack cocaine use, meaning they maintained at low level or reduced their use. Although both the standard and enhanced intervention groups made substantial improvement in their crack cocaine use, individuals in the enhanced intervention group were statistically more likely to reduce their risk than those assigned to the standard intervention (83% vs. 75%, P < 0.05). As for the number of sex partners, 75% of the overall sample improved; that is, they reduced the number of sex partners or remained abstinent or in a one-partner relationship at baseline and follow-up. There was no statistically significant difference between the enhanced and standard groups (76% vs 73%). Stratified by gender, the results showed a trend toward improvement among women assigned to the enhanced intervention compared with those assigned to the standard. In terms of condom use, the overall sample worsened more than it improved (65% vs. 44%), and no differences were found between the enhanced and standard groups.
These findings show that the use of peers as role models in promoting HIV risk reduction is feasible and effective among out-of-treatment drug abusers, particularly for drug use itself. Condom use was found to be more difficult to change than other behaviors. Possible reasons for this lack of improvement and suggestions for future interventions are given.
本章旨在描述一项随机研究（由美国国家药物滥用研究所[NIDA]资助）的结果，该研究比较了由同伴提供的强化干预与NIDA标准干预在降低人类免疫缺陷病毒（HIV）风险行为方面的效果。
数据来自正在进行的圣路易斯“人人为师”（EOTO）研究，该研究针对未接受治疗的快克可卡因使用者和注射吸毒者（IDU）的HIV风险行为展开。该研究采用随机前瞻性设计，在本章中，分析了三种风险行为——快克可卡因的使用频率、性伴侣数量以及过去30天内的避孕套使用情况。我们报告了基线水平和三个月随访期的风险程度，以根据二分结果确定个体改善或恶化的比例，在该二分结果中，保持低风险或降低中度或高风险行为被视为“改善”，而风险行为增加或保持中度或高风险则被视为“恶化”。
总体而言，80%的样本“改善”了他们的快克可卡因使用情况，即他们维持在低水平或减少了使用量。尽管标准干预组和强化干预组在快克可卡因使用方面都有显著改善，但强化干预组的个体在统计学上比分配到标准干预组的个体更有可能降低风险（83%对75%，P<0.05）。至于性伴侣数量，总体样本中的75%有所改善；也就是说，他们减少了性伴侣数量，或在基线和随访时保持禁欲或处于单一伴侣关系。强化组和标准组之间没有统计学上的显著差异（76%对73%）。按性别分层后，结果显示，与分配到标准干预组的女性相比，分配到强化干预组的女性有改善的趋势。在避孕套使用方面，总体样本恶化的情况多于改善的情况（65%对44%），强化组和标准组之间未发现差异。
这些研究结果表明，在未接受治疗的药物滥用者中，将同伴作为榜样来促进降低HIV风险是可行且有效的，特别是对于药物使用本身。研究发现，避孕套使用情况比其他行为更难改变。文中给出了这种改善不足的可能原因以及对未来干预措施的建议。
