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Longitudinal Study of the RAP Peer Intervention for HIV Prevention
Research Method: Intervention Research
Principal Investigator: Margaret R. Weeks, PhD.
Grant: National Institute on Drug Abuse (NIDA) 1 R01 DA13356
Partners: Community residents (Peer Health Advocates)
Dates of Study: 2005-2008

Background
Injection drug and crack cocaine use are associated with increased exposure to blood-borne and sexually transmitted diseases, including HIV, which often results from sharing of injection equipment, sex-for-drug exchanges, or unprotected sex while high. Over the past decade, research has shown that peer-delivered interventions reduce HIV risk among these populations by creating change on multiple levels. Interventions such as the Risk Avoidance Partnership (RAP) train active drug users to engage in safer behavior, helping individuals to see themselves as positive role models. Advocating these safer practices to their peers spreads risk avoidance and harm reduction practices within and across social networks. On the community level, reinforcing prevention norms changes the environment of high drug and sexual-risk settings. The Longitudinal Study of the RAP Peer Intervention for HIV Prevention will assess the long-term reduction of risk and harm at the individual, peer and community levels. It will also provide specific insights into factors and processes that lead to positive effects, and make a peer-driven HIV intervention sustainable over time.

Previous ICR studies COPE I and COPE II, based in social service organizations, briefly reduced individual risk behavior among active drug users in Hartford; however, their impacts diminished over time. The Study of High-Risk Drug Use Settings for HIV Prevention revealed close connections among many heroin and cocaine users in Hartford, CT, and therefore the potential for drug-using members to diffuse an HIV intervention through these social networks. HIV Prevention in High-Risk Drug Use Sites: Project RAP trained active drug users to become Peer Health Advocates (PHAs) who model HIV risk-reduction behavior and disseminate prevention materials to their own network members, in the places where they use drugs. This peer-delivered intervention may have longer-term effectiveness than interventions delivered by professional outreach or services organizations. The Longitudinal Study of the RAP Peer Intervention for HIV Prevention will help researchers understand what factors lead peer-delivered interventions with drug users to diminish, continue, or self-generate over time.

Project Goals and Objectives

Assess the long-term effects of the Risk Avoidance Partnership (RAP) Peer Health Advocate (PHA) training program in Hartford, CT.
Assess how the process of delivering the RAP intervention affects the risk reduction attitudes and behaviors of PHAs.
Assess how the RAP intervention affects the HIV risk reduction attitudes and behaviors of PHAs' drug using networks and of the larger drug using community in Hartford.

Identify factors that successfully sustain the intervention over time.

Project Details
To assess changes over time in HIV risk behavior associated with the RAP intervention, project staff will repeat survey interviews with Peer Health Advocates (PHAs), their original Contact Referrals (CRs), and at least one new Contact Referral from their current social networks. PHAs' responses will be compared to those from their initial intake to the study 2-2 1/2 years ago and a follow-up survey conducted 6 months after intake. ICR will continue to support the Community Advocacy Group, in which trained RAP PHAs meet monthly to build their knowledge and skills, socialize, stock up on prevention materials, and discuss important issues in their communities. Ethnographers will continue to observe these sessions as well as active drug-use sites. Further, in-depth interviews with PHAs, CRs, and other drug users will document the provision, effects, diffusion and sustainability of the intervention, and the effects of social activism on PHAs' health behavior. Finally, project staff will conduct a repeat "community-wide survey" with 500 PHAs, CRs, and other drug users in Hartford utilizing a Respondent Driven Sampling method (where participants refer other eligible people they know to the study). This information will be compared to the community-wide survey from the original RAP study, in which 400 drug users participated. The study will collect data about individuals' exposure to RAP and/or other interventions, their personal networks, current HIV risk, changes in HIV-risk behavior, and participation in social action such as peer health advocacy.

Project Contact:
Margaret R. Weeks, PhD.
Principal Investigator

(860) 278-2044 ext. 229

Project Staff:
ICR

Margaret R. Weeks, PhD.
Principal Investigator

Kim Radda, MA., RN.
Co-Investigator

Jianghong Li, MD
Co-Investigator,

Statistical Data Analyst

Julia Dickson-Gomez, Ph.D.
Co-Investigator, Ethnographic Coordinator

Maria Martinez
Project Coordinator

Eduardo Robles
Outreach Interviewer,

Intervention Facilitator

David Walker
Outreach Interviewer, Intervention Facilitator

Mark Convey, MA
Ethnographer