Effects of an HIV peer prevention intervention on sexual and injecting risk behaviors among injecting drug users and their risk partners in Thai Nguyen, Vietnam: A randomized controlled trial

Abstract

Globally, 30% of new HIV infections outside sub-Saharan Africa involve injecting drug users (IDU) and in many countries, including Vietnam, HIV epidemics are concentrated among IDU. We conducted a randomized controlled trial in Thai Nguyen, Vietnam, to evaluate whether a peer oriented behavioral intervention could reduce injecting and sexual HIV risk behaviors among IDU and their network members. 419 HIV-negative index IDU aged 18 years or older and 516 injecting and sexual network members were enrolled. Each index participant was randomly assigned to receive a series of six small group peer educator-training sessions and three booster sessions in addition to HIV testing and counseling (HTC) (intervention; n = 210) or HTC only (control; n = 209). Follow-up, including HTC, was conducted at 3, 6, 9 and 12 months post-intervention. The proportion of unprotected sex dropped significantly from 49% to 27% (SE (difference) = 3%, p < 0.01) between baseline and the 3-month visit among all index-network member pairs. However, at 12 months, post-intervention, intervention participants had a 14% greater decline in unprotected sex relative to control participants (Wald test = 10.8, df = 4, p = 0.03). This intervention effect is explained by trial participants assigned to the control arm who missed at least one standardized HTC session during follow-up and subsequently reported increased unprotected sex. The proportion of observed needle/syringe sharing dropped significantly between baseline and the 3-month visit (14% vs. 3%, SE (difference) = 2%, p < 0.01) and persisted until 12 months, but there was no difference across trial arms (Wald test = 3.74, df = 3, p = 0.44).

Addressing the needs of sexual partners of people who inject drugs through peer prevention programs in Iran

“…In other words, sexual partners of PWID would encourage their partners to take their medications and in fact they would be protecting themselves. A notable profit of such programs would be increasing sexual partners of PWIDs' access to both healthcare and education along with decreasing their risky behaviour (7,8). In conclusion, we suggest implementing peer counselling and education programs among sexual partners of PWID.…”

“…In conclusion, we suggest implementing peer counselling and education programs among sexual partners of PWID. Similar projects, elsewhere in Asia, have shown promising results in increasing the level of knowledge and practice of partners (7,8). Findings of studies in Vietnam for example, suggested that sexual partners of PWID could be reached, and their relationships were improved and consistent condom use was increased through peer based HIV prevention interventions (8).…”

Psychosocial and psychopathological predictors of HIV-risk injecting behavior among drug users in Portugal

“…Some studies reported that education about HIV transmission in IDUs is a necessary and efficient way to reduce injecting risk behaviors (Aspinall et al, 2013;Go et al, 2013;MackesyAmiti et al, 2013), but itself alone is not totally accepted as a sufficient vector on HIV prevention (Madray & van Hulst, 2000;Palmateer, 2010;Sarkar et al, 1995). Furthermore, our results do not corroborate other authors who defend the efficacy of NSP in reducing injecting risk behaviors (Palmateer et al, 2010).…”

“…Education about risk behaviors is generally accepted as an effective way to prevent HIV/AIDS infection (Des Jarlais & Semaan, 2008) and there is evidence of a significant reduction of risk behaviors associated with syringe sharing among high risk IDUs who had a peer education intervention about HIV risk behaviors (Go et al, 2013;Mackesy-Amiti et al, 2013). Other authors argue that education alone is not sufficient in reducing risk among IDUs (Madray & van Hulst, 2000), because HIV transmission among IDUs still happens, and also because risk taking behaviors among IDUs in some studies were not influenced by knowledge about HIV transmission and prevention, educational status or history of HIV testing or serostatus (Sarkar et al, 1995).…”

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

“…Twenty-four trials were included in the meta-analysis. 22,[68][69][70][71][72][73]75,76,81,82,173,175,179,180,182,186,188,189,[192][193][194][195]197 The reasons for excluding eight trials from the meta-analysis were not providing the number of PWID for control and intervention groups at follow-up, 84,174,176,177,196 only providing risk ratios, 178 outcome combined HIV infections with sexually transmitted infections 77 and data for 'unsafe injection practices' were presented only at baseline. 74 …”