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Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador

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Abstract

This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3–4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.

Resumen

La investigación consistió en evaluar el efecto de una intervención comunitaria con el objetivo de reducir el riesgo de VIH en usuarios de crack residentes de comunidades de bajo ingreso en San Salvador, El Salvador. La intervención consiste de 3 componentes, los cuales se implementaron de forma secuencial: (1) pruebas rápidas de VIH en comunidades; (2) promoción de la prueba de VIH por medio de la red social; (3) talleres impartidos a grupos pequeños de usuarios de crack que se conocen entre sí. Se utilizó un diseño de series de tiempo interrumpido para evaluar el efecto de la intervención. El estudio consistió en administrar 7 ciclos de encuestas seccionales a usuarios de crack reclutados por medio de la metodología conocida como muestreo por medio del participante o “respondent driven sampling”. Cada ciclo de encuesta se administró cada 3–4 meses a partir de la implementación de un componente de la intervención y se administraron 1579 encuestas. Los resultados indicaron que la muestra fue expuesta a los componentes de la intervención a través del tiempo y aproximadamente 50% de los encuestados reportaron haber participado en uno de los componentes de la intervención. Los participantes que reportaron haber recibido una prueba de VIH en los sitios donde se implementó la intervención, comparados con los que no fueron expuestos a la intervención, reportaron una reducción en el número de relaciones sexuales sin condón (p < 0.05). Haber hecho una prueba de VIH por referencia de otro usuario de crack resulto en una reducción en el número de relaciones sexuales sin condón (p < 0.05). Se detectó una relación entre número de componentes de la intervención al cual fueron expuestos los participantes y sexo sin uso de condón (p < 0.05). A pesar de que la intervención penetro las comunidades bajo estudio, y que se detectó una asociación entre la participación en los varios componentes de la intervención y reducción en conductas sexuales de riesgo, no se detectó una reducción en las conductas sexuales de riesgo a través del tiempo en la muestra entera. Para reducir conductas de riesgo a nivel población es necesario que las intervenciones de salud pública penetren la población de interés. intervenciones.

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Funding

The research reported in this paper was supported in whole or party by the National Institute on Drug Abuse (2 R01DA020350) and the National Institute on Mental Health (5P30MH57226).

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Authors and Affiliations

  1. Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA

    Julia Dickson-Gomez, Sergey Tarima & Laura R. Glasman

  2. Department of Psychology, College of Education, Lehigh University, Bethlehem, PA, USA

    Julia Lechuga

  3. Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador

    Gloria Bodnar

  4. Universidad Centroamericana, José Simeón Cañas, Managua, USA

    Lorena Rivas de Mendoza

Authors
  1. Julia Dickson-Gomez
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  2. Sergey Tarima
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  3. Laura R. Glasman
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  4. Julia Lechuga
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  5. Gloria Bodnar
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  6. Lorena Rivas de Mendoza
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Correspondence to Julia Dickson-Gomez.

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All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by Institutional Review Boards at the Medical College of Wisconsin and the Universidad Centroamericana José Simeón Canas.

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Written informed consent was obtained from anyone who participated in any intervention component or completed a survey.

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Dickson-Gomez, J., Tarima, S., Glasman, L. et al. Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador. AIDS Behav 23, 1147–1157 (2019). https://doi.org/10.1007/s10461-018-2314-z

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