Outreach in natural settings: The use of peer leaders for HIV prevention among injecting drug users' networks

Objective. Guided by a social influence and empowerment framework, peer lea ders in the injecting drug user (IDU) community were trained to promote hum an immunodeficiency virus (HIV) prevention among their contacts within and beyond their sex and drug networks, Methods. From 1994 to 1995 in Baltimore, Maryland, 36 peer leaders who part icipated in the IO-session training program were administered pretest and p osttest surveys. Evaluation included leaders' self-reported HIV-related beh aviors and outreach activities, Survey data also were collected from 78 of the leaders' risk network members Results. Peer leaders reported a significant increase in condom use and in cleaning used needles with bleach. The leaders' risk network members, compa red with controls, were significantly more likely to report greater needle hygiene. In an assessment of diffusion of information, the majority of risk network members who were current injectors reported receiving needle-clean ing materials from the leaders, and the majority of risk network members we re able to correctly identify the HIV prevention slogans that had been taug ht to the leaders. The leaders documented 2165 HIV prevention interactions, of which 84% were with active drug users. Conclusions. The results from this study suggest that, in the IDU community , training peer leaders as HIV educators may promote HIV prevention among t he leaders' risk network members and others at risk of acquiring and transm itting HIV. This training also may provide the leaders with effective proso cial roles.