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

Institute for Community Research, Hartford, Connecticut 06106, USA.
Substance Use &amp Misuse (Impact Factor: 1.23). 02/2009; 44(2):253-81. DOI: 10.1080/10826080802347677
Source: PubMed


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-user 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.

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Available from: Jianghong Li, Oct 05, 2015
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    • "Facilitators also reported improving their own injection practices following the IS Team education campaign. This is consistent with examinations of peer leaders within larger social network interventions showing that peers involved in education and outreach report the greatest reductions in injection risk behaviours after a follow-up period [27,28,30,53,54]. The results of this study suggest that employing non-users in prevention and intervention work restricts IDU from receiving the aforementioned benefits of this type of work, while evidence indicates that they may in fact be the most suitable candidates to deliver educational messages. "
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    ABSTRACT: Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education.
    Harm Reduction Journal 03/2013; 10(1):4. DOI:10.1186/1477-7517-10-4 · 1.26 Impact Factor
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    • "VANDU representatives are being increasingly involved in policy meetings, including in the national AIDS strategy [26]. Another article that highlights the important work of VANDU encourages PWUD to be more actively involved in Table 1 Documents included in the literature review (Continued) Latkin et al. 2003 Intervention study USA To investigate whether a networkoriented peer outreach intervention is associated with HIV prevention among drug users In the experimental group, participants were 3 times more likely to report reduction in injection risk behavior and 4 times more likely to report increased condom use than controls; peer outreach strategies may be useful in reducing HIV risk behaviors in drug using communities Purcell et al. 2007 Intervention study USA To investigate the efficacy of a peer HIV prevention program with PWUD through a project called the Risk Avoidance Partnership* project Participants reported significant reductions of injection and sexual risk behaviors compared to baseline but there were no significant changes in medical outcomes Weeks et al. 2009 "
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    ABSTRACT: Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995--2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD in policy and program development, our findings revealed a lack of published data on the implementation of these efforts. Gaps in the current evidence highlight the need for additional research to explore and document the engagement of PWUD in the areas of policy and program development. Further, efforts to minimize stigmatizing barriers associated with illicit drug use are urgently needed to improve the engagement of PWUD in decision making processes.
    Substance Abuse Treatment Prevention and Policy 11/2012; 7(1):47. DOI:10.1186/1747-597X-7-47 · 1.16 Impact Factor
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    • "Our finding that participants who have previously been to the MSHRC were more likely to get peer-delivered HIV testing suggests that drug user-run drop-in centers may serve as an additional setting for the delivery of healthcare services to Thai IDU. This supports a large body of evidence which demonstrates the value of peer-run interventions in supporting and increasing access to public health programs [16, 43, 44]. While offering services at a peer-run harm reduction center may be effective in attracting a larger number of IDU, a study by Kerr and colleagues found that female IDU were less likely to access the MSHRC [18]; yet the findings from the present study indicate that female IDU may be more willing to access peer-delivered pre-test counseling. "
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    ABSTRACT: Peer-based models for human immunodeficiency virus (HIV) testing have been implemented to increase access to testing in various settings. However, little is known about the acceptability of peer-delivered testing and counseling among people who inject drugs (IDU). During July and October 2011, data derived from the Mitsampan Community Research Project were used to construct three multivariate logistic regression models identifying factors associated with willingness to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling. Among a total of 348 IDU, 44, 38, and 36 % were willing to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling, respectively. In multivariate analyses, factors associated with willingness to access peer-delivered pre-test counseling included: male gender (adjusted odds ratio (AOR) = 0.48), higher than secondary education (AOR = 1.91), and binge drug use (AOR = 2.29) (all p < 0.05). Factors associated with willingness to access peer-delivered rapid HIV testing included: higher than secondary education (AOR = 2.06), binge drug use (AOR = 2.23), incarceration (AOR = 2.68), avoiding HIV testing (AOR = 0.24), and having been to the Mitsampan Harm Reduction Center (AOR = 1.63) (all p < 0.05). Lastly, binge drug use (AOR = 2.40), incarceration (AOR = 1.94), and avoiding HIV testing (AOR = 0.23) (all p < 0.05) were significantly associated with willingness to access peer-delivered post-test counseling. We found that a substantial proportion of Thai IDU were willing to receive peer-delivered HIV testing and counseling. These findings highlight the potential of peer-delivered testing to complement existing HIV testing programs that serve IDU.
    Journal of Community Health 11/2012; 38(3). DOI:10.1007/s10900-012-9635-z · 1.28 Impact Factor
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