Developing a Culturally-Adapted Computerized Family-Based Intervention to Prevent Drug Abuse and HIV Among Youth in Central Asia

Objective: Located on the major drug trafficking route from Afghanistan, Central Asia and Kazakhstan, in particular, are experiencing one of the fastest growing rates of HIV infection in the world, disproportionately affecting young people. The country’s HIV prevention efforts are limited to a knowledge-based approach, which does not equip at-risk youth with skills required to deal with situations of risk exposure. Parents or other adult family members, who represent a significant protective force in a family-oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan. Few culturally tailored family-based HIV and substance abuse prevention programs are available for at-risk youth.

Methods: We used qualitative data from the NIDA-funded study aiming to develop a culturally adapted family-based intervention for at-risk 15-17 year old adolescents living in areas of Almaty, Kazakhstan highly affected by heroin trade and injection drug use. Eligible youth had at least one risk factor (i.e., substance-using peers or friends, parental history of drug use or alcohol problems, parental criminal history, history of drug use). We analyzed data from three semi-structured focus groups with 15 adolescents and three focus groups with 15 parents and other caregivers (grandparents, aunts, uncles). Each group met three times.

Results: Adolescents provided contextual narratives of how episodes of sexual risks and substance use evolve in communities with high availability of drugs. Family conflicts about youths’ risk behaviors are widespread and caregivers feel unprepared to deal with rising drug use and HIV epidemic.  Caregivers’ discussed various barriers to open discussion and identified effective communication and problem solving techniques among the most important intervention components. Extended family networks can be instrumental in prevention process particularly in families with parental history of substance use. The study also identified how to access and retain at-risk families in drug-affected communities and overcome potential barriers that may impede intervention participation.

Conclusions: The study offers strategies for adapting intervention content and delivery techniques to a new population and cultural milieu. The study findings improve scientific knowledge about the tailoring and cultural adaptation of HIV and drug abuse prevention programs for at-risk youth in the context of a concentrated HIV epidemic driven by injection drug use. In low resource and traditional countries like Kazakhstan, interventions should address the dual risk of HIV and substance use, combine empirically tested skills-based and family involvement approaches, involve extended family members and utilize interactive technologies to develop engaging and cost-effective tools with high fidelity and easy scalability.