Provider Perspectives on the Relationships between Social Networks and Vulnerability to HIV/AIDS Among Street-Connected Youth in Tbilisi, Georgia

Background and purpose: Social networks have emerged as a defining characteristic in shaping vulnerability to HIV/AIDS among key populations. Street-connected youth, defined as young people aged 10-19 years old who spend most of their time living and/or working on the street, are highly vulnerable to HIV/AIDS. Studies estimate that 2,500 street-connected youth live in the Republic of Georgia, with approximately 1,000 residing in the capital city of Tbilisi. In recent years, social service organizations have developed to meet the complex needs of street-connected youth, many of whom are vulnerable to social, economic and sexual exploitation and abuse. Despite this growth, relatively little research has examined how social service providers understand the social networks of street-connected youth and how these networks affect their vulnerability to HIV/AIDS and other health problems. The present paper interviewed key informants who provide services to street-connected youth in order to understand provider perspectives on the social networks of street-connected youth, and how network characteristics shape vulnerability to HIV.

Methods: Trained interviewers conducted individual semi-structured interviews with 22 key informants (68% female; 32% male) from governmental institutions and social service organizations (n=6 social workers, n=5 psychologists, n=5 peer educators, n=4 managers and n=2 mobile health officers). Informants were asked to discuss their perspectives in three areas: (1) the social network characteristics of street-connected youth, (2) youth’s involvement in substance use and sexual behaviors related to HIV/AIDS, and (3) the social contexts of youth engagement and service delivery. Interviews were conducted in Georgian and a written transcript was produced for each interview. Three independent coders conducted a content analysis of the data in Dedoose using a theoretically-grounded codebook and open coding. Forwards-backwards translation methods were used to translate informant quotes into English to ensure linguistic and cultural equivalence.

Results: Providers perceived that youth were embedded in ethnically homogenous networks that reflected ethnic segregation in Georgian society. Providers discussed how the presence of family members in the networks of street-connected youth conferred exposure to HIV-infection. Providers perceived that the highest risks were for native Georgian youth who had run away from home and were involved in commercial sex work. In contrast, youth from other ethnic groups were often in social networks that contained family members who protected them from sex work. However, Kurdish-Azeri youth—also embedded in networks with family—were reported as engaging in commercial sex work. The presence of sex work in social networks was directly connected to economic stress, with more marginalized networks being more vulnerable to commercial sex work. In addition, Kurdish-Azeri youth were identified as experiencing additional vulnerability, as official resources are not available to this ethnic group.

Implications and conclusion: Study findings highlight the different role of family members and economic marginalization in shaping street-connected youth’s vulnerability to HIV. Network-based approaches need to consider the whole network and the resources and constraints within the network. Additional resources are needed to support Kurdish-Azeri youth, who experience additional stigma and are often excluded from accessing social and health services.