In this longitudinal study, researchers designed a two-arm, randomized trial to evaluate the effects of an HIV prevention intervention with social networks among young men who have sex with men (MSM) in St. Petersburg, Russia and Sofia, Bulgaria.

At high-risk community venues, researchers recruited 276 MSM composing 52 social networks. Participants were assessed for risk characteristics and counseled for risk reduction, and researchers administered sociometric measures to empirically identify the social leader of each network.

Leaders of the 25 experimental-condition networks took a nine-session training and guidance program on delivering ongoing, theory-based HIV prevention advice to peers. In succession, social leaders targeted network members' AIDS risk-related knowledge, risk-reduction norms, attitudes, intentions, and self-efficacy. At three and 12 months, risk surveys were readministered to participants.

Among the intervention-group network, reported unprotected intercourse (UI) declined from 71.8 percent to 48.4 percent at three months (P=0.0001). The proportion engaging in UI with multiple partners fell from 31.5 percent to 12.9 percent (P=0.02). The effects were attenuated at 12 months, but were maintained among participants who had recent multiple sex partners. Little change was observed in the control-group network.

"Interventions that engage the identified influence leaders of at-risk [young MSM] social networks to communicate theory-based counseling and advice can produce significant sexual risk behavior change," concluded authors. "This model is culturally pertinent for HIV prevention efforts in former socialist countries, as well as elsewhere for other hard-to-reach vulnerable community populations."

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