Peer-delivered interventions reduce HIV risk behaviors among out-of-treatment drug abusers

Objective, The purpose of this chapter is to describe the results of a rand omized study (funded by the National Institute on Drug Abuse [NIDA]) compar ing a peer-delivered enhanced intervention to the NIDA standard interventio n for reducing human immunodeficiency virus (HIV) risk behaviors, Methods. Data come from the ongoing St. Louis EachOneTeachOne (EOTO) study on HIV risk behaviors among out-of-treatment crack cocaine users and inject ing drug users (IDUs), The study has a randomized prospective design, and f or this chapter, three risk behaviors were analyzed-the frequency of crack cocaine use and the number of sex partners and condom use over the past 30- day period, We report the level of risk at baseline and at the three-month follow-up period to determine the proportion of individuals improving or wo rsening based on a dichotomous outcome in which remaining at low risk or de creasing moderate or high risk behaviors is considered "improving" and incr easing risk behavior or remaining at moderate or high risk is considered "w orsening." Results. Overall, 80% of the sample "improved" their crack cocaine use, mea ning they maintained at low level or reduced their use. Although both the s tandard and enhanced intervention groups made substantial improvement in th eir crack cocaine use, individuals in the enhanced intervention group were statistically more likely to reduce their risk than those assigned to the s tandard intervention (83% vs. 76%, P < 0.05). As for the number of sex part ners, 75% of the overall sample improved; that is, they reduced the number of sex partners or remained abstinent or in a one-partner relationship at b aseline and follow-up. There was no statistically significant difference be tween the enhanced and standard groups (76% vs. 73%). Stratified by gender, the results showed a trend toward improvement among women assigned to the enhanced intervention compared with those assigned to the standard. In term s of condom use, the overall sample worsened more than it improved (65% vs. 44%), and no differences were found between the enhanced and standard grou ps. Conclusions. These findings show that the use of peers as role models in pr omoting HIV risk reduction is feasible and effective among out-of-treatment drug abusers, particularly for drug use itself. Condom use was found to be more difficult to change than other behaviors. Possible reasons for this l ack of improvement and suggestions for future interventions are given.