The influence of a peer-based HIV prevention intervention on conversation about HIV prevention among injection drug users in Baltimore, Maryland
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Background STEP into Action assessed the effectiveness of a peer-based HIV prevention intervention on the reduction in risk behaviors among injection drug users (IDUs) in Baltimore. This analysis examined the effect of the peer-based intervention on (i) the change in frequency of conversation about HIV prevention topics over time among IDUs, (ii) sustainability of the change in frequency of the conversation, and (iii) which topics IDUs were more likely to discuss at the end of the follow-up period. Methods Of 227 Index participants 114 were randomized into intervention and 113 into control group. Participants were 18 years of age or older and self-reported injecting drugs in the 6 months prior to enrollment in the trial. Data were collected prospectively at 6, 12, and 18 months. The outcome of interest was the frequency of conversation among IDUs about different HIV prevention topics. Results Retention of the participants in the study exceeded 80% for each of the 3 visits. The odds of talking ‘at least a few times a week’ compared to ‘never’ about HIV testing (odds ratio (OR) = 1.86; 95% confidence interval (CI) = 0.87 - 3.95), HIV transmission (OR = 3.22; 95% CI = 1.39 - 7.46), needle cleaning (OR = 4.35; 95% CI = 1.88 - 10.07), needle sharing (OR = 4.35; 95% CI = 1.80 - 10.54), and condom use (OR = 2.25; 95% CI = 1.05 - 4.84) were higher in the intervention group compared to the control group at 6 months. At 18 months odds ratios that remained statistically significant were only for conversation about the danger of needle sharing (odds ratio (OR) = 3.21; 95% CI = 1.45 - 7.14) and condom use (OR = 2.81; 95% CI = 1.28 - 6.17). Conclusions This study demonstrated that the intervention had a positive influence on the conversation about HIV prevention among IDUs, but the sustainability of the high frequency of conversation past 6 months remained a challenge for most of the conversation topics. Thus, the findings suggest that interventions should be designed to constantly reinforce positive behavior among IDUs.