Cumulative Effects of Adding a Small Group Intervention to Social Network Testing on HIV Testing Rates Among Crack Users in San Salvador, El Salvador.

The present study evaluates a combination prevention intervention for crack users in San Salvador, El Salvador that included social network HIV testing, community events and small group interventions. We examined the cumulative effects of the social network HIV testing and small group interventions on rates of HIV testing, beyond the increase that we saw with the introduction of the social network HIV testing intervention alone. HIV test data was converted into the number of daily tests and analyzed the immediate and overtime impact of small group interventions during and in the twelve weeks after the small group intervention. The addition of the small group interventions to the baseline of monthly HIV tests resulted in increased rates of testing lasting 7 days after the small group interventions suggesting a reinforcing effect of small group interventions on testing rates.

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

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.

Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections Among Crack Users in San Salvador.

In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ(2)(1, N = 799) = 4.23, p = .040). Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals.

With God's help i can do it: crack users? Formal and informal recovery experiences in El Salvador.

Crack use has increased dramatically in El Salvador in the last few decades. As with other developing countries with sudden onsets of drug problems, El Salvador has few medical staff trained in addictions treatment. Little research has examined drug users? attempts to reduce or abstain from drug use in countries where government-regulated formal medical treatment for drug addiction is scarce. This paper uses qualitative and quantitative data gathered from active crack users to explore their formal and informal strategies to reduce or abstain from drugs, and compares these with components of informal and formal treatment in developed countries.