The Influence of a Peer-Based HIV Prevention Intervention on Conversation about HIV Prevention Among Injection Drug Users in Baltimore, Maryland

Introduction: STEP into Action assessed the efficacy of a peer-based HIV prevention intervention that trained participants to use a communication technique to promote HIV risk reduction with peers on the reduction in risk behaviors among people who inject drugs  (PWID) in Baltimore. This analysis examined the effect of the intervention on (i) the change in frequency of conversation about HIV prevention topics over time among PWID, (ii) sustainability of the change in frequency of the conversation, and (iii) which topics PWID were more likely to discuss at the end of the follow-up period. Methods: Of 227 participants 114 were randomized into intervention and 113 into control group. Data were collected prospectively at 6, 12, and 18 months. Retention of the participants in the study exceeded 80% for each of the 3 visits. Results: The intervention group talked more frequently about any of the HIV prevention topics compared to the control group at 6 months post intervention. At 18 months odds ratios remained statistically significant for conversation about the danger of needle sharing (odds ratio (OR) = 3.21; 95% confidence interval (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 PWIDs, 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 PWIDs.