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.

Roma, the largest ethnic minority group in Central and Eastern Europe, have cultures that are traditional, often closed, and autonomous of majority populations. Roma communities are characterized by pervasive social health problems, widespread poverty, limited educational opportunities, and discrimination. Although some evidence suggests high levels of HIV sexual risk behaviour among Roma, little is known about the cultural and social context in which risk behaviour occurs. In-depth interviews were used to elicit detailed information about types of sexual partnerships and sexual risk behaviour practices occurring in them, use and perception of protection, knowledge and beliefs about AIDS and STDs, and sexual communication patterns in a sample of 42 men and women aged 18-52 living in Roma community settlements in Bulgaria and Hungary. Analysis of the interview data revealed that men have great sexual freedom before and during marriage, engage in a wide range of unprotected practices with primary and multiple outside partners, and have much more relationship power and control. In contrast, women are expected to maintain virginity before marriage and then sexual exclusivity to their husbands. Condom use is not normative and is mainly perceived as a form of contraception. Although awareness of AIDS was common, it was generally not perceived as a personal threat. Misconceptions about how HIV is transmitted are widespread, and women - in particular - had very little knowledge about STDs, HIV transmission, and protective steps. There is an urgent need for the development of HIV prevention programs culturally sensitive to Roma populations in Eastern Europe, where HIV rates are rapidly rising.

One's social network was the most powerful predictor of HIV risk behavior. HIV/STD prevention interventions directed toward entire social networks are especially promising.

Introduction Roma (Gypsies), the largest and most disadvantaged ethnic minority group in Europe, are believed to be vulnerable to HIV/AIDS. This study’s aim was to examine HIV risk in 6 Roma male sociocentric networks (n=405 men) in Bulgaria. Methods Participants were interviewed concerning their risk practices and tested for HIV/STDs. Results High-risk sexual behaviors were common. Over 57% of men had multiple sexual partners in the past 3 months. Over one-third of men reported both male and female partners in the past year. Condom use was low. Greater levels of sexual risk were associated with lower intentions and self-efficacy for using condoms, drug use, having male partners, knowing HIV-positive persons, and having higher AIDS knowledge but no prior HIV testing. Two men had HIV infection, 3.7% gonorrhea, and 5.2% chlamydia. Discussion HIV prevention interventions directed toward high-risk social networks of Roma are needed before HIV infection becomes more widely established.

РезюмеНастоящата статия представя резултати от проведени количествени и качествени изследвания сред млади хора с лека до умерена степен на интелектуално затруднение на възраст 18 -40 години, посещаващи Дневен център за трудови умения. Целта на изследването е да се идентифицират неформалните лидери, да се опишат личностните им характеристики, и особеностите на лидерството сред тази група. Използваните методи са: социометрично изследване, цветови тест на Люшер и Личностен въпросник на Айзенк. Събраните данни и анализираните резултатите сочат, че степента на интелектуално затруднение не влияе върху избора на неформален лидер. Определящи характеристики са мотивацията за самоусъвършенстване и налагане на собствения авторитет сред другите (определени по цветови тест на Люшер), както и ниските показатели по скала "Невротизъм" от Личностния въпросник на Айзенк. Ключови думи: интелектуално затруднение, лидерство, тревожност, екстроверсия, социометрия AbstractThis article presents the results of qualitative and quantitative studies conducted among young people with mild to moderate intellectual disability, aged 18-40 who attended a Daycare center for working skills. The aim of the study was to identify the informal leaders among the participants and to describe some leadership features in this group. The used methods were a sociomertic study, the Lüscher color-test and the Eysenck Personality Inventory. The summarized results showed that the degree of intellectual disability did not affect the choice of an informal leader. The important determinants were the motivation for self-improvement and imposing authority among others (found by means of Lüscher color test), and the low scores on scale "Neuroticism" from Eysenck Personality Inventory.