Objectives: To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU).
Design: We conducted a randomized controlled trial involving HIV and HCV antibody-negative IDU, aged 15–30 years, recruited in five United States cities. A six-session, small-group, cognitive behavioral, skills-building intervention in which participants were taught peer education skills (n = 431) was compared with a time-equivalent attention control (n = 423). Baseline visits included interviews for sociodemographic, psychosocial, and behavioral factors during the previous 3 months; HIV and HCV antibody testing; and pre/posttest counselling. Procedures were repeated 3 and 6 months postintervention.
Results: The intervention produced a 29% greater decline in overall injection risk 6 months postintervention relative to the control [proportional odds ratio 0.71; 95% confidence limit (CL) 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-years) did not differ significantly across trial arms (relative risk 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed.
Conclusion: Interventions providing information, enhancing risk-reduction skills, and motivating behavior change through peer education training can reduce injection risk behaviors, although risk elimination might be necessary to prevent HCV transmission.
From the aDivision of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
bJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
cNational Research and Development Institutes, New York, New York, USA
dHealth Research Association, Los Angeles, California, USA
eNew York Academy of Medicine, Center for Urban Epidemiologic Studies, New York, New York, USA
fUniversity of Illinois at Chicago, School of Public Health, Chicago, Illinois, USA
gUniversity of California San Diego, School of Medicine, San Diego, California, USA
hPublic Health Seattle and King County, Seattle, Washington, USA
iGeorge Washington University, School of Public Health and Health Services, Washington, DC, USA.
Received 12 October, 2006
Revised 30 March, 2007
Accepted 11 April, 2007
Correspondence to Richard S. Garfein, PhD, MPH, Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine, University of California San Diego, School of Medicine, 9500 Gilman Drive, Mail Code 0622, San Diego, CA 92093-0622, USA. Tel: +1 858 822 3018; fax: +1 858 534 4642; e-mail: email@example.com