Robert S. Broadhead, Ph.D., University of Connecticut Pavlo Smyrnov, Oleksandra Datsenko and Oksana Matiyash International HIV/AIDS Alliance in

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1 Robert S. Broadhead, Ph.D., University of Connecticut Pavlo Smyrnov, Oleksandra Datsenko and Oksana Matiyash International HIV/AIDS Alliance in Ukraine

2 Robert S. Broadhead, Ph.D., University of Connecticut Pavlo Smyrnov, International HIV/AIDS Alliance in Ukraine Oleksandra Datsenko, International HIV/AIDS Alliance in Ukraine Gordon Gauchat, University of Connecticut Casey Borch, University of Alabama

3 The model was developed and piloted by Robert S. Broadhead Ph.D, University of Connecticut and his colleague Douglas Heckathorn, Corwell University in 1980s as an alternative to outreach It was implemented in USA, China, Vietnam, Russia and Ukraine The PDI is a chain-referral outreach model developed for accessing and educating IDUs in the community to prevent HIV and related diseases

4 With special recruiting coupons and existing peer networks PDI model provides access to IDUs not attracted to HR projects, to hidden populations in closed drug scenes Incentives and bonus-rewards are provided to target specific sub-groups of IDUs

6 RECRUITING IDUs for interview and education EDUCATING IDUs in new prevention information about HIV and other healthrelated issues TEACHING IDU to share information with peers DISTRIBUTING harm reduction materials REFERRING IDUs for HIV and STI testing on-site

8 New information and skills building Interaction Peer pressure and norms Rewards Repetition All of the above occurring in combination

9 The first 5 pilot projects started in April 2007 The goal of 5 PDI pilot projects was to examine opportunities of coverage scale up by recruiting 500 new IDU in each site from hard to reach populations: young IDU < 25 years old, women IDU and stimulant IDU

11 Sites Kryvyi Rig Odessa Zaporizhya Mykolayiv Bila Tserkv N a < 25 40% 94% 70% 49% 38% Female age 38% 32% 33% 40% 14% Stimulant users 30% 38% 57% 26% 36%

12 50% 40% 30% 20% 10% 0% Zaporozhye Odesa Mykolayv Kryviy Rig HIV Positive HBV/HCV positive

13 Total Males Females Age group N % HIV+ n N % HIV+ n N % HIV+ n < 20 years old 93 11% % % % % % 81 > % % % 86

14 IDUs < 20 years old were 3 times less likely to be infected with HIV than IDUs > 25. Thus young IDUs are the highest target-group for HIV prevention efforts. Women-IDUs, regardless of age, were at app. twice the risk of becoming HIV infected than men. Thus women-idus should be singled-out for prevention services, and especially women-idus < 20 years.

15 Unprotected sex: < >25 Total Men Women Average N Average N Average N

16 Correlation between age, gender and successful prevention education Knowledge Total Males Females Score Age group Mean (out of 8) N Mean (out of 8) N Mean (out of 8) < (1.688) 211 (1.855) (1.136) (1.677) (1.777) (1.424) > (1.988) (2.001) (1.948) N

17 Women scored higher than men on knowledge test IDUs, who are < 25 scored statistically significantly higher on the knowledge test than IDUs over > 25 Therefore the educational efforts were more successful among targeted IDU subgroups

18 The PDI projects demonstrated quick access to large numbers of IDUs specifically from targeted subgroups The PDI worked best among IDUs < 25 years old in disseminating HIV prevention information in the community. Prevention services should be specially designed to attract young IDUs, women and stimulant users

21 Up to 20 new PDI projects started in December 2009 More than 10 PDI follow up projects started in August 2010 to assess potential behavioral change among injecting drug users within 6 months and more Educational module for IDUs is being constantly improved (including special unit for stimulant users) The research on IDUs behavior characteristics is being implemented based on more than 9,000 risk-assessment interview questionnaires. The PDI model has been successfully piloted among sex workers in January June, 2010

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