HIV Risk Behavior Patterns, Predictors, and Sexually Transmitted Disease Prevalence in the Social Networks of Young Roma (Gypsy) Men in Sofia, Bulgaria

Abstract

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.

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

“…4 8 Studies with community samples of young Roma men in Bulgaria have shown high rates of unprotected sexual intercourse, frequent multiple sexual partnerships with both women and men, low levels of condom use, and prevalent sexually transmitted diseases. [9][10][11] In recent trials undertaken with young men who have sex with men in Russia and Bulgaria, 12 13 we found that an HIV prevention approach that trains social network leaders to function as risk reduction counsellors and advocates significantly reduced levels of high risk sexual practices among others in the social networks. We conducted a randomised controlled trial of a social network-level HIV prevention in a Roma settlement in Sofia, Bulgaria.…”

The HIV Type 1 Epidemic in Bulgaria Involves Multiple Subtypes and Is Sustained by Continuous Viral Inflow from West and East European Countries

“…For example, 21.5% of commercial sex workers, 6.7% of the Roma community, and 2.4% of intravenous drug users were found positive for syphilis. 2,3 Our findings suggest that HIV-1 infection has been present in Bulgaria for at least the past two decades and established three main characteristics of the epidemic: first, a high genetic heterogeneity in terms of circulating subtypes; second, several independent transmission clusters within subtype A1 and B (the two most represented subtypes in the screened sample), indicating multiple introductions over time but only limited introduction from countries of the FSU; and third, a dynamic HIV-1 gene inflow and outflow from/to West Europe and other East European countries.…”

“…2 However, the high incidence of HCV infection and syphilis and the high level of risk behavior in these population groups suggest that they are quite vulnerable to HIV infection and thus represent a potential source of infection. [3][4][5] Following the end of the cold war a decade ago, most Balkan countries have been affected by dramatic political and socioeconomic changes, which could contribute to the spread of HIV infection. Given the central geographic location of Bulgaria at the crossing point between Western Europe, Eastern Europe, and the Middle East, defining the origin and evolution of HIV in Bulgaria has obvious epi-demiological relevance.…”

Review of HIV vulnerability and condom use in central and eastern Europe

“…Studies among Bulgarian Roma men found very high rates of high-risk behaviors. 69,70 Most men in a Roma community settlement sample in Sofia, Bulgaria had multiple sexual partners in the past 3 months and 77% did not use condoms during their most recent vaginal intercourse. 70 Almost three-quarters of men in this study practiced anal sex with females, and only one in four of these acts were protected.…”