Research

Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: randomised controlled trial

BMJ 2006; 333 doi: 10.1136/bmj.38992.478299.55 (Published 23 November 2006)
Cite this as: BMJ 2006;333:1098
  1. Jeffrey A Kelly, professor of psychiatry and behavioural medicine1,
  2. Yuri A Amirkhanian, assistant professor of psychiatry and behavioural medicine2,
  3. Elena Kabakchieva, director and chair3,
  4. Sylvia Vassileva, project coordinator3,
  5. Boyan Vassilev, psychologist3,
  6. Timothy L McAuliffe, professor of psychiatry and behavioural medicine and biostatistics1,
  7. Wayne J DiFranceisco, senior research scientist1,
  8. Radostina Antonova, psychologist3,
  9. Elena Petrova, senior assistant professor of dermatology and venereology4,
  10. Roman A Khoursine, research associate5,
  11. Borislav Dimitrov, assistant professor of dermatology and venereology6
  1. 1Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, Wisconsin 53202, USA
  2. 2CAIR, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, and Municipal Hospital for Infectious Diseases, Mirgorodskaya 3, St Petersburg 193167, Russia
  3. 3Health and Social Development Foundation, Sofia 1606, Bulgaria
  4. 4Department of Dermatology and Venereology, Medical University of Sofia, Sofia 1606, Bulgaria
  5. 5Municipal Hospital for Infectious Diseases, St Petersburg, Russia
  6. 6Department of Dermatology and Venereology, Military Medical Academy, Sofia 1606, Bulgaria
  1. Correspondence to: J A Kelly kdemming{at}mcw.edu
  • Accepted 20 September 2006

Abstract

Objective To determine the effects of a behavioural intervention for prevention of HIV and sexually transmitted diseases that identified, trained, and engaged leaders of Roma (Gypsy) men's social networks to counsel their own network members.

Design A two arm randomised controlled trial.

Setting A disadvantaged, impoverished Roma settlement in Bulgaria.

Participants 286 Roma men from 52 social networks recruited in the community.

Intervention At baseline all participants were assessed for HIV risk behaviour, tested and treated for sexually transmitted diseases, counselled in risk reduction, and randomised to intervention or control groups. Network leaders learnt how to counsel their social network members on risk prevention. Networks were followed up three and 12 months after the intervention to determine evidence of risk reduction.

Main outcome measure Occurrence of unprotected intercourse during the three months before each assessment.

Results Reported prevalence of unprotected intercourse in the intervention group fell more than in control group (from 81% and 80%, respectively, at baseline to 65% and 75% at three months and 71% and 86% at 12 months). Changes were more pronounced among men with casual partners. Effects remained strong at long term follow-up, consistent with changes in risk reduction norms in the social network. Other measures of risk reduction corroborated the intervention's effects.

Conclusions Endorsement and advice on HIV prevention from the leader of a social network produces well maintained change in the reported sexual practices in members of that network. This model has particular relevance for health interventions in populations such as Roma who may be distrustful of outsiders.

Trial registration Clinical Trials NCT00310973.

Footnotes

  • Contributors: JAK (principal investigator and guarantor) and YAA (co-principal investigator) were responsible for the trial, intervention design, assessment protocol, and the primary writing. EK was the principal investigator and directed scientific activities in Bulgaria. SV was project coordinator, oversaw recruitment, and managed site data. TLMcA was senior biostatistician, and WJDiF analysed the data. They planned and carried out the statistical analyses and wrote the statistical methods and results sections. RA and BV were responsible for overseeing delivery of the intervention and quality control. EP directed the laboratory testing, RAK planned and directed the sociometric network analyses, and BD directed treatment of sexually transmitted diseases.

  • Funding: Grants R01-MH64410 and P30-MH52776 from the US National Institute of Mental Health.

  • Competing interests: None declared.

  • Ethical approval: Institutional review board of the Medical College of Wisconsin and ethics committee of the Health and Social Development Foundation in Sofia, Bulgaria.

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