Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Background: Accumulating research has highlighted the importance of the social context in understanding sexual HIV risk behaviors among drug users, which may in turn inform the design of effective strategies to reduce HIV risks among individuals and their social networks. Although extensive research has been conducted on social networks among drug users, little research has attempted to examine collectively the effect of structural characteristics of social networks and the positive and negative influence of network members' behaviors on sexual risk behaviors among men in drug treatment. Methods: For this study, 351 men were randomly selected from a methadone maintenance treatment program (MMTP) in NewYork City and completed a structured interview. Information about a participant's social network was elicited using the Social Network and Support Questionnaire which asked the participant to report his frequent contacts, with friends, sexual partners, family members or relatives, neighbors and/or coworkers. Among these contacts, the participant was asked to choose a maximum of 5 people (i.e. “alters”) with whom he had frequent contact. The social network questions focused on the participant's reports of each alter's sociodemographics, HIV risk behaviors and support for risk reduction. Logistic regression was used to estimate the associations between network HIV risk and positive influence characteristics as independent variables and participants' sexual risk behaviors as outcome variables with covariance adjustment for network structure and participants' sociodemographic variables. Results: The average age of the sample was 44 years and the majority identified as Latino (45%) or African American (38%). With respect to frequent contacts in the past 30 days, participants reported an average of 3.9 network members or alters. Multiple logistic regression analyses indicated that (1) a higher level of perceived sexual risk among network alters was significantly associated with an increased likelihood of the participant engaging in sexual risk behaviors; (2) participants who indicated that they exchanged encouragement with a higher number of network alters about using condoms were less likely to report engaging in unprotected sex , and (3) participants who indicated that they talked about HIV risks with a higher number of network alters were less likely to engage in unprotected sex in the past 6 months. Conclusions: The study suggests that network members may directly influence a participant's sexual behavior by virtue of engaging in risky sexual behavior with participants, or they may have a broader social influence by serving as role models with regard to engaging or not engaging in HIV risk behaviors or by socially interacting with participants to create positive peer norms around HIV risk reduction. HIV prevention approaches should consider the different aspects of social networks which may be harnessed in promoting risk reduction. Additional implications of the findings for HIV prevention network interventions for men in MMTPs will be discussed.