Research That Matters (January 17 - 20, 2008)

Background: Central Asia is experiencing one of the fastest growing HIV epidemics in the world driven by injecting drug use, with infection rates in some regions rising by more than 50% since 2004. In 2004, 3.2% of injecting drug users (IDUs) in Kazakhstan were estimated to be infected with HIV; in 2006, 10.4% of IDUs were estimated to be HIV infected. The widespread patterns of drug-related and sexual risk behaviors and the sharply rising rates of HIV and sexually transmitted infections (STIs) among IDUs and their sexual partners in Kazakhstan all underscore the need for effective behavioral interventions which address both sexual and drug-related HIV risk behaviors. The aim of this study was to develop and test the feasibility of a couples-based HIV/STI risk reduction intervention (CHSR) and to examine the preliminary effects of the CHSR on HIV risk behavioral outcomes among 40 IDUs and their main sexual partners in Shu, Kazakhstan. This trial was conducted between June 2005 and April 2006.

Methods: We screened 120 potential participants who were recruited from the Republican AIDS Center Needle Exchange program in Shu, Kazakhstan. Of the 120 participants, 40 couples (N=80 participants) met eligibility criteria (i.e. injected drugs in the past 90 days and had unprotected vaginal sex with the study partner in the past 90 days), enrolled in the study and completed a baseline interview. Of the 40 couples, 20 couples were randomized to the CHSR intervention (n=40 participants, two cohorts of 10 couples) and 20 couples were randomized to the Wellness promotion comparison condition (WP) (n=40 participants, two cohorts of 10 couples). The CHSR intervention included 3 single gender, 2-hour group sessions with the male and female partners followed by an individual couple 2-hour session. The WP intervention consisted of 4 mixed couple 2-hour group sessions. Participants were assessed with repeated measures at 3-month post intervention follow-up with a 95% retention rate. The average attendance rate for the CHSR sessions was 98.7% and the average rate for WP sessions was 91.8%.

Results: At baseline, participants reported an average of 10 (SD=4.7) unprotected acts of vaginal sex in the past 30 days. Participants reported sharing needles with an average of 3.7 (SD=2.0) individuals in the past 30 days and used unclean needles 63% of the times they injected in the past 30 days. Compared to WP participants, CHSR participants were significantly more likely to report a higher proportion of condom use during vaginal sex and fewer number of acts of unprotected vaginal sex, lower number and proportion of injection acts in which syringes or needles are shared and fewer people with whom participant shared needles from baseline to 3-month follow-up. No adverse events were detected.

Conclusion: This pilot trial demonstrated the feasibility and safety of the CHSR and showed preliminary effects of the CHSR in decreasing the number and proportion of injection acts in which needles and syringes are shared, reducing the number of partners with whom they shared needles and in decreasing the number and proportion of unprotected sex acts.