Effects of a social network HIV/STD prevention intervention for MSM in Russia and Hungary: a randomized controlled trial

Abstract

Objective: To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections.

Design: A two-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling.

Setting: St. Petersburg, Russia and Budapest, Hungary.

Participants: Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size = 35 members, n = 626) were recruited.

Intervention: Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members.

Main outcome and measures: Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes.

Results: There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P = 0.04); UAI with a nonmain partner (P = 0.04); and UAI with multiple partners (P = 0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P = 0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P = 0.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks.

Conclusion: Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.

Trial registration: ClinicalTrials.gov NCT00838773.

Figures

Figure 1

Depiction of a 3-ring sociocentric MSM social network in Hungary. The dark shaded circle at the figure's center is the seed. First-, second-, and third-ring network members extending outward from the seed are shown by progressively lighter respective shading. Data visualization: Borgatti SP. NetDraw Graph Visualization Software. Harvard: Analytic Technologies, 2002.

Figure 2

Trial Consort Diagram.

Figure 3

(a) Changes in median frequency of UAI in the past 3 months among all men in intervention and comparison networks (n=586). (b) Changes in median UAI in the past 3 months among intervention and comparison network members who reported multiple partners at baseline (n=360).