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  • Title: Risk contexts and risk behaviors in the Euregion Maas-Rhein: the Boule de Neige intervention for AIDS prevention among drug users.
    Author: Franken IH, Kaplan CD.
    Journal: AIDS Educ Prev; 1997 Apr; 9(2):161-80. PubMed ID: 9167801.
    Abstract:
    Using targeted sampling, self-reported data of 1,767 drug users in the Euregion Maas-Rhein were collected over 3 years. Forty-two percent of the injection drug users shared syringes with sexual partners and 47.8% with friends. Eighty-one percent of the total sample had sexual contact in the last 6 months, half of whom with one person and half with two or more. Significant predictors of high-risk drug use were injecting in the presence of others, injection onset before the age of 20, female gender, and not living in The Netherlands. Participation in needle exchange or methadone programs and sufficient knowledge of risk factors was not significantly related to a reduction of high-risk drug use behavior. High-risk sexual behavior was found to be related to male gender, under the age of 30 and to multiple sexual partners. We conclude that in a social context where needle exchange, methadone programs, and sufficient knowledge of risk factors among the drug user population exist, AIDS prevention can be improved through behavioral skills training and developing specific interventions that target the peer group environments, rituals, partner relationships, and lifestyles of drug users. A 3-year (1992-94) prospective study of 1767 drug users from the Euregion Maas-Rhein evaluated a peer counseling intervention for reducing risk behaviors associated with HIV transmission. The HIV prevalence among drug users in this diverse Dutch, German, and Belgian area ranges from 10% to 30%. Duties of the paid peer counselors included promotion of HIV risk reduction in drug use and sexual behavior; administration of questionnaires; distribution of educational materials, condoms, and clean needles; identification of hidden subgroups in the target population; and the development of prevention materials. 50% of those reached by peer counselors had no prior contact with drug abuse services. Although drug users claimed syringes and condoms were readily available, high-risk drug and sexual behaviors were widespread. 52% were injecting drugs and 24.4% had traded drugs for sex. Condoms were used by 24.8% during sexual contacts with a main partner and by 73.5% during sex with casual partners. 47.8% of injecting drug users had shared their syringes with friends. Condom use was significantly higher among drug users residing in South Limburg, women, those over 30 years of age, and those with multiple sex partners. These findings suggest that existing HIV risk-reduction interventions such as methadone treatment and needle exchange may not be sufficient. More emphasis must be placed on personal skills training (e.g., assertiveness training) and peer-driven, lifestyle-oriented processes.
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