Peer counselling versus standard‐of‐care on reducing high‐risk behaviours among newly diagnosed HIV‐positive men who have sex with men in Beijing, China: a randomized intervention study

Abstract

IntroductionReducing high‐risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer‐ counselling in reducing high‐risk behaviours among newly diagnosed HIV‐positive Chinese men who have sex with men (MSM).MethodsWe randomized 367 newly diagnosed HIV‐positive men to either standard‐of‐care (SOC; n = 183) or peer‐counselling intervention (n = 184), and followed them for 12 months (visit at 0‐, 3‐, 6‐, 9‐ and 12‐month). SOC participants received counselling on high‐risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre‐post diagnosis high‐risk behaviour change; logistic regression was used to assess the likelihood of practicing high‐risk behaviours between intervention and SOC participants. Both intent‐to‐treat and per‐protocol (full‐dosage) approaches were used for the analyses.ResultsFor pre‐ and post‐diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent‐to‐treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per‐protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98).ConclusionsWe observed a 14 to 43% decrease in the prevalence of selected high‐risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer‐counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM.Clinical Trial Number: NCT01904877

Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

“…Ten studies generated [17,20,29,42,43,46,55,[57][58][59] 11 independent effect sizes on unprotected sex with a combined study population of 6289. Four of the articles showed a significant reduction in unprotected sex, while four of the articles showed a non-significant reduction.…”

“…Previous studies have shown that peer education could reduce risk behaviors [15,16] and promote health [17][18][19][20][21], but some researchers measured the influence of peer-based intervention on conversations about HIV prevention and highlighted the effect declined and the frequency of conversations on the topics decreased [22]. Previous meta-analyses only synthesized the effect of peer education in developing countries in general population [8] and only revealed the effect of peer education on condom use [17] or HIV testing [23] among MSM groups. What's more, it is also still unclear whether peer education can bring about positive effects and maintain the changes consistently among different high risk HIV groups both in developed and developing countries.…”

Association between stigma towards HIV and MSM and intimate partner violence among newly HIV-diagnosed Chinese men who have sex with men

“…The data for this analysis were from the baseline surveys of a randomized clinical trial called the China MP3 Project. This project had two study phases and was described in detail elsewhere [32]. In brief, men who lived in Beijing, self reported having sex with another man, were 18 years or older and willing to provide written informed consent were recruited (via short message service, website advertisement, gay-frequented venue outreach and peer referral) and tested for HIV in the Phase I and completed a cross-sectional survey.…”

HIV incidence and cohort retention among men who have sex with men in Hangzhou, China

“…Self-discrimination could lead to high-risk sexual behaviors. [30,31] Multiple comprehensive HIV intervention programs have been implemented targeting Chinese MSM in recent years, including treatment of HIV/STIs and provision of pre-exposure prophylaxis, [32–34] but these programs often lacked of psychological counseling on acceptance of their sexual identity among MSM.…”