VOICE: A prevention intervention for HIV seropositive (HIV+) injection drug users (IDUs)

NOTE: This study has ended.

VOICE wais the San Francisco Bay Area arm of a national randomized controlled trial of a prevention intervention working with HIV-positive injection drug-using women, men and transgender persons. The VOICE intervention was created from the input of HIV+ injectors, who shared with us how they were coping with HIV, their prevention needs, and their ideas about what kind of program would be effective for them. The intervention seeks:

  • To reduce sexual and drug use practices that could transmit HIV
  • To increase access to and use of HIV primary health care
  • To increase access and adherence to HIV treatments

Formative research: The VENUS study

The VENUS Study was a formative research study with the following goals:

  • Describe the sexual and drug-injection practices among HIV+ IDUs
  • Identify psychological, social and sexual contexts of HIV transmission risk among HIV+ IDUs
  • Identify feasible intervention strategies to promote safer sexual and drug use practices among HIV+ IDUs

Results of the VENUS Study guided the development of VOICE.

Program overview

Based on our formative research, we designed a peer mentorship training intervention that teaches HIV+ IDUs risk reduction and health care management skills while highlighting their importance as valuable mentors to other HIV+ IDUs. Because HIV+ IDUs often have problematic relationships with services, this intervention includes an experimental agency volunteer component to increase service delivery knowledge, utilization and resource expertise.

  • Each site attempted to recruited about 250 HIV+ IDUs with opposite sex partners and a history of IDU in the past year
  • Baseline and 3- 6- and 12-month follow-up surveys on ACASI assessed sex and drug use risk behaviors, access to and utilization of HIV care and adherence to HIV medications
  • CD4 and Viral Load Tests at Baseline, 6- and 12-Month visits

Participants in the study were randomly selected into one of two programs. Both programs were group-based and involve videos and discussion. One group trained participants to become peer mentors so they could take steps to improve their own health and the health of others. The other group addressed multiple issues important in the lives of HIV+ injection drug users. The groups occured over five weeks.

  • Peer Mentor Intervention: Seven group sessions, two individual sessions, and one Peer Volunteer Activity at a community agency
  • Video Discussion Intervention: 8 group sessions based on watching and discussing videos on a range of topics including criminal justice system, overdose, disclosure of HIV to children

Participants completed surveys at an in-take visit before the groups start and at 3, 6 and 12 months after the groups have finished. All participants were compensated for their time and effort at every study visit. Some participants returned for qualitative de-brief interview post-study.

Preliminary results

279 HIV+ IDU men and women were recruited from San Francisco and the East Bay.

  • Demographics:
    • 58% men, 34% women, 9% transgender;
    • 65% African American, 18% Latino, 10% White, 7% Asian/Pacific Islander;
    • mean age 42 years old;
    • 71% history of incarceration.
  • Participant retention was excellent, with a 91% overall follow-up rate and a 96% 12-month follow-up rate of reachable participants.
  • Primary healthcare visits in the past 6 months: None = 21%, 1-3 = 30%, 4 or more = 49%
  • Medication experience: Currently on HIV medication = 47%; Not on meds but CD4 count less than 200 = 9%; 100% adherence yesterday = 81%, past 7 days = 67%
  • Number of sexual partners: 0 = 8.3%, 1 = 40.3%, 2 = 14.5%, 3 = 13%, 4 or more = 24%

Please see the VOICE slide show from the CAPS 2005 Community Briefing.

Project staff

The VOICE study staff included researchers, outreach workers and interviewers.

Collaborative partners

Center for AIDS Prevention Studies
Johns Hopkins University
New York Academy of Medicine
University of Miami, Florida

Sponsored by:
Centers for Disease Control & Prevention
Heath Services and Resources Administration (HRSA)