Harnessing peer networks as an instrument for AIDS prevention: Results from a peer-driven intervention

Objective. Since 1985, community outreach efforts to combat acquired immuno deficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of th is traditional outreach model with an innovative social network model, term ed "a peer-driven intervention" (PDI), The latter provides IDUs with guidan ce and structured incentives that permit them to play a much more active ro le in the outreach process, thereby harnessing peer pressure on behalf of h uman immunodeficiency virus (HIV) prevention efforts, Methods. We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut, Comparisons are based on the number and representative ness of IDUs recruited at each site, the effectiveness of HIV prevention ed ucation, compliance rates with AIDS risk reduction recommendations, and rel ative cost, The analyses are based on 552 initial interviews and 190 six-mo nth follow-up interviews conducted during the first two years of each inter vention's operation. Results, Both interventions produced significant reductions in HIV risk beh aviors, as measured using self-reports. The PDI outperformed the traditiona l intervention with respect to the number of IDUs recruited, the ethnic and geographic representativeness of the recruits, and the effectiveness of HI V prevention education. In addition, the costs of recruiting IDUs into the intervention and educating them about HIV in the community was only one-thi rtieth as much in the PDI as in the traditional intervention. Conclusions. The findings suggest that given guidance and nominal incentive s, IDUs can play a more extensive role in community outreach efforts than t he traditional model allows. The findings also suggest that both interventi ons reduce HIV-associated risk behaviors, but the PDI reaches a larger and more diverse set of IDUs, and does so at much less expense.