Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: randomised controlled trial
Open accessAbstract
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.
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Because the leaders come from the community and are embedded within the community, the interventions have the potential to be more sustainable.
“Finally, because the leaders come from the community and are embedded within the community, the interventions have the potential to be more sustainable [59].”
From Social Network Analysis for Program Implementation (2015) · cites this paper as [59]
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- Authors
- Kelly, J. A., Amirkhanian, Y. A., Kabakchieva, E., Vassileva, S., Vassilev, B., McAuliffe, T. L., DiFranceisco, W. J., Antonova, R., Petrova, E., Khoursine, R. A., & Dimitrov, B.
- Affiliations
- Medical College of Wisconsin (US)
- Health and Social Development Foundation (BG)
- Medical University of Sofia (BG)
- Military Medical Academy (BG)
- Corresponding author
- Kelly, Jeffrey A
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2006-10-13
- Volume
- 333
- Issue
- 7578
- Pages
- 1098
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1661707
- OpenAlex
- W1980922489
- Cited by
- 120
- References
- 25
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 5 · 2016: 10 · 2015: 5 · 2014: 10 · 2013: 6 · 2012: 12
- FWCI
- 19.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Mental Health (P30 MH52776, P30MH052776, R01-MH64410, R01MH064410)
- Topics
- Health Sciences › Health Professions › General Health Professions › Romani and Gypsy Studies
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- HIV prevention, sexually transmitted infections, social networks, behavioral interventions, unprotected sex, sexual risk reduction, casual sex partners, Roma settlements
- MeSH terms
- Adult, Bulgaria, Romani People, Humans, Male, Sexual Partners, Sexually Transmitted Diseases, Social Support, HIV Infections, Prevalence, Risk Assessment, Unsafe Sex
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