Broadhead R S, Heckathorn D D, Weakliem D L, Anthony D L, Madray H, Mills R J, Hughes J
Department of Sociology, University of Connecticut, Storrs 06269-2068, USA.
Public Health Rep. 1998 Jun;113 Suppl 1(Suppl 1):42-57.
Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of this traditional outreach model with an innovative social network model, termed "a peer-driven intervention" (PDI). The latter provides IDUs with guidance and structured incentives that permit them to play a much more active role in the outreach process, thereby harnessing peer pressure on behalf of human immunodeficiency virus (HIV) prevention efforts.
We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut. Comparisons are based on the number and representativeness of IDUs recruited at each site, the effectiveness of HIV prevention education, compliance rates with AIDS risk reduction recommendations, and relative cost. The analyses are based on 522 initial interviews and 190 six-month follow-up interviews conducted during the first two years of each intervention's operation.
Both interventions produced significant reductions in HIV risk behaviors, as measured using self-reports. The PDI outperformed the traditional intervention with respect to the number of IDUs recruited, the ethnic and geographic representativeness of the recruits, and the effectiveness of HIV prevention education. In addition, the costs of recruiting IDUs into the intervention and educating them about HIV in the community was only one-thirtieth as much in the PDI as in the traditional intervention.
The findings suggest that given guidance and nominal incentives, IDUs can play a more extensive role in community outreach efforts than the traditional model allows. The findings also suggest that both interventions reduce HIV-associated risk behaviors, but the PDI reaches a larger and more diverse set of IDUs, and does so at much less expense.
自1985年以来，美国针对注射吸毒者开展的防治获得性免疫缺陷综合征（艾滋病）的社区外展工作，绝大多数依赖于一种提供者-客户模式，该模式依靠专业外展工作者团队。我们报告了这种传统外展模式与一种创新的社交网络模式（称为“同伴驱动干预”[PDI]）的比较情况。后者为注射吸毒者提供指导和结构化激励措施，使他们能够在外展过程中发挥更积极的作用，从而利用同伴压力推动人类免疫缺陷病毒（HIV）预防工作。
我们比较了在康涅狄格州东部和中部中等规模城镇实施的传统外展干预（TOI）和同伴驱动干预的成效。比较基于每个地点招募的注射吸毒者的数量和代表性、HIV预防教育的效果、艾滋病风险降低建议的依从率以及相对成本。分析基于在每种干预措施实施的头两年进行的522次初始访谈和190次为期六个月的随访访谈。
根据自我报告衡量，两种干预措施均使HIV风险行为显著减少。在招募的注射吸毒者数量、招募对象的种族和地域代表性以及HIV预防教育的效果方面，同伴驱动干预优于传统干预。此外，将注射吸毒者纳入干预措施并在社区对其进行HIV教育的成本，同伴驱动干预仅为传统干预的三十分之一。
研究结果表明，在给予指导和名义激励的情况下，注射吸毒者在外展工作中可以发挥比传统模式更大的作用。研究结果还表明，两种干预措施都能减少与HIV相关的风险行为，但同伴驱动干预覆盖了更多、更多样化的注射吸毒者群体，且成本低得多。
