High-risk sexual behavior, HIV/STD prevalence, and risk predictors in the social networks of young Roma (Gypsy) men in Bulgaria.

Roma (Gypsies), the largest and most disadvantaged ethnic minority group in Europe, are believed to be vulnerable to HIV/AIDS. This study's aim was to examine HIV risk in 6 Roma male sociocentric networks (n = 405 men) in Bulgaria. Participants were interviewed concerning their risk practices and tested for HIV/STDs. High-risk sexual behaviors were common. Over 57% of men had multiple sexual partners in the past 3 months. Over one-third of men reported both male and female partners in the past year. Condom use was low. Greater levels of sexual risk were associated with lower intentions and self-efficacy for using condoms, drug use, having male partners, knowing HIV-positive persons, and having higher AIDS knowledge but no prior HIV testing. Two men had HIV infection, 3.7% gonorrhea, and 5.2% chlamydia. HIV prevention interventions directed toward high-risk social networks of Roma are needed before HIV infection becomes more widely established.

Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: randomised controlled trial.

OBJECTIVE: To determine the effects of a behavioural intervention for prevention of HIV and sexually transmitted diseases that identified, trained, and engaged leaders of Roma (Gypsy) men's social networks to counsel their own network members. DESIGN: A two arm randomised controlled trial. SETTING: A disadvantaged, impoverished Roma settlement in Bulgaria. PARTICIPANTS: 286 Roma men from 52 social networks recruited in the community. INTERVENTION: At baseline all participants were assessed for HIV risk behaviour, tested and treated for sexually transmitted diseases, counselled in risk reduction, and randomised to intervention or control groups. Network leaders learnt how to counsel their social network members on risk prevention. Networks were followed up three and 12 months after the intervention to determine evidence of risk reduction. MAIN OUTCOME MEASURE: Occurrence of unprotected intercourse during the three months before each assessment. RESULTS: Reported prevalence of unprotected intercourse in the intervention group fell more than in control group (from 81% and 80%, respectively, at baseline to 65% and 75% at three months and 71% and 86% at 12 months). Changes were more pronounced among men with casual partners. Effects remained strong at long term follow-up, consistent with changes in risk reduction norms in the social network. Other measures of risk reduction corroborated the intervention's effects. CONCLUSIONS: Endorsement and advice on HIV prevention from the leader of a social network produces well maintained change in the reported sexual practices in members of that network. This model has particular relevance for health interventions in populations such as Roma who may be distrustful of outsiders. TRIAL REGISTRATION: Clinical Trials NCT00310973.

HIV risk behavior patterns, predictors, and sexually transmitted disease prevalence in the social networks of young Roma (Gypsy) men in Sofia, Bulgaria.

OBJECTIVES AND GOAL: This research studied predictors of high-risk sexual practices and sexually transmitted disease (STD) prevalence among Roma (Gypsy) men's social networks in Sofia, Bulgaria. STUDY DESIGN: Fifty-four socially active individuals, approached in Roma neighborhood venues, recruited members (n = 296) of their own networks into the study. Participants completed sociometric and risk behavior interviews and were tested for chlamydia, gonorrhea, syphilis, and trichomonas. RESULTS: Men had a mean of 7 partners in the past year. Fifty-nine percent had multiple partners in the past 3 months. Seventy-three percent reported recent unprotected vaginal and 51% unprotected anal intercourse. Fifty-nine percent of men had sex with other men in the past year. Twenty-two percent had one of the STDs. The social network to which an individual belonged accounted for 23% to 27% of variance in predicting sexual risk behavior. CONCLUSIONS: One's social network was the most powerful predictor of HIV risk behavior. HIV/STD prevention interventions directed toward entire social networks are especially promising.