Outcomes of a Peer HIV Prevention Program with Injection Drug and Crack Users: The Risk Avoidance Partnership

摘要

The Risk Avoidance Partnership (RAP) Project conducted in Hartford, Connecticut, tested a program to train active drug injectors and crack cocaine users as “Peer Health Advocates” (PHAs) to deliver a modular HIV, hepatitis, and STI prevention intervention to hard-to-reach drug users in their networks and others in the city. The intervention was designed to diffuse health promotion and risk reduction interventions by supporting PHAs to model prevention practices and deliver risk and harm reduction materials and information. We compared change in behaviors and attitudes between baseline and 6-month follow-up of 112 primarily African American and Latino PHAs, 223 of their drug-network Contact Referrals, and 118 other study recruits (total n=523). Results indicated significant HIV risk reduction among all study participants, associated with significant health advocacy action conducted by PHAs, and a relationship between exposure to the RAP peer-delivered intervention and risk reduction among all study groups. Findings suggest that active drug users' engagement in peer health advocacy can set in motion a feedback and diffusion process that supports both the continued work of the PHAs and the adoption of harm reduction and mimicking of health advocacy by their peers.