Outreach in natural settings: the use of peer leaders for HIV prevention among injecting drug users' networks.

OBJECTIVE Guided by a social influence and empowerment framework, peer leaders in the injecting drug user (IDU) community were trained to promote human immunodeficiency virus (HIV) prevention among their contacts within and beyond their sex and drug networks. METHODS From 1994 to 1995 in Baltimore, Maryland, 36 peer leaders who participated in the 10-session training program were administered pretest and posttest surveys. Evaluation included leaders' self-reported HIV-related behaviors and outreach activities. Survey data also were collected from 78 of the leaders' risk network members. RESULTS Peer leaders reported a significant increase in condom use and in cleaning used needles with bleach. The leaders' risk network members, compared with controls, were significantly more likely to report greater needle hygiene. In an assessment of diffusion of information, the majority of risk network members who were current injectors reported receiving needle-cleaning materials from the leaders, and the majority of risk network members were able to correctly identify the HIV prevention slogans that had been taught to the leaders. The leaders documented 2165 HIV prevention interactions, of which 84% were with active drug users. CONCLUSIONS The results from this study suggest that, in the IDU community, training peer leaders as HIV educators may promote HIV prevention among the leaders' risk network members and others at risk of acquiring and transmitting HIV. This training also may provide the leaders with effective prosocial roles.