Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: randomised controlled trial

Abstract

Objective 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. Design A two arm randomised controlled trial. Setting A disadvantaged, impoverished Roma settlement in Bulgaria. Participants 286 Roma men from 52 social networks recruited in the community . Intervention 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. Main outcome measure Occurrence of unprotected intercourse during the three months before each assessment. Results 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. Conclusions 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. Trial registration Clinical Trials NCT00310973.

Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence

“…The intervention increased knowledge on tobacco risks and motivated six children (from a class of 50) to attempt to quit smoking. Kelly et al 133 describes a RCT of the use of influential peers to deliver a safe-sex message to their community. Following the intervention, there was a significantly lower rate of unprotected sex reported by recipients in the intervention arm and a non-significant trend to a lower proportion of sexually transmitted infections.…”

“…It therefore seems highly plausible that the underlying mechanism that led to the intervention success was cognitive engagement from the individual risk-takers, and their observed change in behaviour. The CMO configuration for Kelly et al 133 is represented in Figure 25.…”

“…133 The key difference is in the negotiation of the topic, which came from a Community member who then 'sounded out' members of her network for their reaction to a sensitive topic in Leeds GATE, but was inexistent in this case. One might wonder why, despite the difference in negotiation, the same strategy of opportunistic conversations triggered cognitive engagement.…”

“…One might wonder why, despite the difference in negotiation, the same strategy of opportunistic conversations triggered cognitive engagement. This may be because while the outreach worker was a trusted member of the Community in Leeds GATE, the authors in Kelly et al 133 purposefully sought a Community member with pre-existing influence. Thus, the profile of the indexes in Kelly et al 133 was sufficiently high in the Community to allow for engagement to happen in spite of the fact that the topic was not negotiated and would have been unlikely to be selected.…”

“…This may be because while the outreach worker was a trusted member of the Community in Leeds GATE, the authors in Kelly et al 133 purposefully sought a Community member with pre-existing influence. Thus, the profile of the indexes in Kelly et al 133 was sufficiently high in the Community to allow for engagement to happen in spite of the fact that the topic was not negotiated and would have been unlikely to be selected. The influential position of index members is likely to have initiated a process whereby talking about risky sexual behaviours, and engaging less in them, became more socially desirable.…”