The Effect of Social Networks and Social Constructions on HIV Risk Perceptions

US black women's pregnancy communication networks: A qualitative network analysis

The ongoing Black maternal health crisis necessitates a closer examination of how Black women in the United States utilize communication to mitigate the dangers racism poses for pregnancy, delivery and the postpartum period. Previous studies have highlighted the importance of supportive networks to Black women's wellbeing during pregnancy. However, few studies utilize a qualitative network approach to explore communication about pregnancy and related risks within a social network. Twenty-eight Black women from 12 US states who self-identified as previously, currently or recently pregnant, were recruited to participate in this study. Following data collection, participants' networks and related commentary from the interview were qualitatively analyzed for composition and context of networks (who is in the network and why?) and the content of communication (what is discussed and how?). This study found that Black women's perceptions of pregnancy risk and enactment of agency in response to risk was influenced by communication with individuals within their communication networks. The findings of this study also demonstrate that emotional support and guidance for navigating the dangers of the healthcare system constituted an important component of communication with strong ties, including partners, family members and close friends. Additionally, Black women enacted agency in response to pregnancy risk by leaning on trusted experts (healthcare providers) within their networks. However, this study also found limitations to the role of pregnancy communication networks. First, negative ties (relations) with alters (individuals with whom Black women have communication ties) and unwanted advice or guidance was found to be a source of stress. Furthermore, although mothers were an essential source of support for many women, differences related to generation, culture and the circumstances of pregnancy limited the relevance of the advice Black women receive from their mothers. Finally, immigrant women faced an additional challenge, as their support networks were sometimes geographically distant from them.

Disease avoidance threatens social cohesion in a large-scale social networking experiment

People tend to limit social contacts during times of increased health risks, leading to disruption of social networks thus changing the course of epidemics. To what extent, however, do people show such avoidance reactions? To test the predictions and assumptions of an agent-based model on the feedback loop between avoidance behavior, social networks, and disease spread, we conducted a large-scale (2,879 participants) incentivized experiment. The experiment rewards maintaining social relations and structures, and penalizes acquiring infections. We find that disease avoidance dominates networking decisions, despite relatively low penalties for infections; and that participants use more sophisticated strategies than expected (e.g., avoiding susceptible others with infectious neighbors), while they forget to maintain a beneficial network structure. Consequently, we observe low infection numbers, but also deterioration of network positions. These results imply that the focus on a more obvious signal (i.e., infection) may lead to unwanted side effects (i.e., loss of social cohesion).

Self-Perception of HIV Risk and Interest in Pre-Exposure Prophylaxis in a General Obstetrics and Gynecology Clinic Population

Background: Pre-exposure prophylaxis (PrEP) for HIV is underutilized, particularly among attendees of obstetrics and gynecology (Ob/Gyn) clinics. Lack of self-perception of HIV risk is a barrier to PrEP utilization, and a lack of understanding of community risk factors for HIV may contribute to that lack of self-perception of risk. Methods: Attendees of general Ob/Gyn clinics in New Orleans completed a survey assessing HIV knowledge, self-perception of HIV risk, and interest in PrEP. They reviewed a brief written educational intervention on demographic and behavioral risk factors for HIV and availability of PrEP. HIV knowledge, self-perception of HIV risk, and interest in PrEP were reassessed after the intervention. Results: One-hundred seventy individuals completed the survey. Eighty-five participants (50%) expressed initial interest in PrEP. Self-perception of risk of HIV acquisition was associated with interest in PrEP. Ten of 11 (90.9%) respondents who had high self-perceived risk of HIV were interested in PrEP, compared with 75 of 159 (47.2%) of those who had low self-perceived risk (p = 0.01). The association remained significant in a multivariate analysis. After the intervention, the number of those who perceived themselves to be at risk of HIV increased from 11 to 25 individuals (p < 0.01) and 20 of these (80%) were interested in PrEP. Knowledge of HIV risk factors increased (p < 0.01). The intervention did not significantly alter interest in PrEP. Conclusions: Self-perception of HIV risk was associated with interest in PrEP. A brief written educational intervention increased knowledge of HIV risk factors and increased self-perception of risk of HIV. The intervention did not translate to increased interest in PrEP.

Epidemiological characteristics of HIV transmission in southeastern China from 2015 to 2020 based on HIV molecular network

Objective

HIV/AIDS remains a global public health problem, and understanding the structure of social networks of people living with HIV/AIDS is of great importance to unravel HIV transmission, propose precision control and reduce new infections. This study aimed to investigate the epidemiological characteristics of HIV transmission in Fujian province, southeastern China from 2015 to 2020 based on HIV molecular network.

Methods

Newly diagnosed, treatment-naive HIV/AIDS patients were randomly sampled from Fujian province in 2015 and 2020. Plasma was sampled for in-house genotyping resistance test, and HIV molecular network was created using the HIV-TRACE tool. Factors affecting the inclusion of variables in the HIV molecular network were identified using univariate and multivariate logistic regression analyses.

Results

A total of 1,714 eligible cases were finally recruited, including 806 cases in 2015 and 908 cases in 2020. The dominant HIV subtypes were CRF01_AE (41.7%) and CRF07_BC (38.3%) in 2015 and CRF07_BC (53. 3%) and CRF01_AE (29.1%) in 2020, and the prevalence of HIV drug resistance was 4.2% in 2015 and 5.3% in 2020. Sequences of CRF07_BC formed the largest HIV-1 transmission cluster at a genetic distance threshold of both 1.5 and 0.5%. Univariate and multivariate logistic regression analyses showed that ages of under 20 years and over 60 years, CRF07_BC subtype, Han ethnicity, sampling in 2015, absence of HIV drug resistance, married with spouse, sampling from three cities of Jinjiang, Nanping and Quanzhou resulted in higher proportions of sequences included in the HIV transmission molecular network at a genetic distance threshold of 1.5% (p < 0.05).

Conclusion

Our findings unravel the HIV molecular transmission network of newly diagnosed HIV/AIDS patients in Fujian province, southeastern China, which facilitates the understanding of HIV transmission patterns in the province.

Health behavior homophily can mitigate the spread of infectious diseases in small-world networks

Research has repeatedly shown that the spread of infectious diseases is influenced by properties of our social networks. Small-world like structures with densely connected clusters bridged by only a few connections, for example, are not only known to diminish disease spread, but also to increase the chance for a disease to spread to any part of the network. Clusters composed of individuals who show similar reactions to avoid infections (health behavior homophily), however, might change the effect of such clusters on disease spread. To study the combined effect of health behavior homophily and small-world network properties on disease spread, we extend a previously developed ego-centered network formation model and agent-based simulation. Based on more than 80,000 simulated epidemics on generated networks varying in clustering and homophily, as well as diseases varying in severity and infectivity, we predict that the existence of health behavior homophilous clusters reduce the number of infections, lower peak size, and flatten the curve of active cases. That is because agents perceiving higher risks of infections can protect their cluster from infections comparatively quickly by severing only a few bridging ties. A comparison with epidemics in static network structures shows that the incapability to act upon risk perceptions and the low connectivity between clusters in static networks lead to diametrically opposed effects with comparatively large epidemics and prolonged epidemics. These finding suggest that micro-level behavioral adaptation to health risks mitigate macro-level disease spread to an extent that is not captured by static network models of disease spread. Furthermore, this mechanism can be used to design information campaigns targeting proxies for groups with lower risk perception.

Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020

Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.

Psychological wellbeing facilitates accurate HIV risk appraisal in gay and bisexual men

Background Accurate HIV risk appraisal is key to effective HIV prevention. This study focuses on the role of psychological wellbeing in determining perceived HIV risk in a sample of gay and bisexual (GBM) in the UK.

METHODS

Overall, 191 HIV-negative GBM completed a cross-sectional survey, in which they provided demographic information and completed measures of engagement in actual sexual risk behaviours, diagnosis with a sexually transmissible infection in the past 12 months, frequency of HIV testing, use of post-exposure prophylaxis (PEP), perceived HIV risk, lesbian, gay, bisexual and transgender (LGBT) identity, sexual identity openness and psychological wellbeing.

RESULTS

Results showed that there was a correlation between engagement in actual HIV risk behaviours and perceived HIV risk, suggesting relatively accurate HIV risk appraisal in the participant sample. LGBT identity and sexual identity openness were associated with increased psychological wellbeing. Structural equation modelling showed that psychological wellbeing has an effect on perceived HIV risk through the mediator of LGBT identity.

CONCLUSIONS

It appears that a state of psychological wellbeing facilitates the construction of a strong and robust LGBT identity, which can be displayed to others, and that a strong LGBT identity in turn facilitates accurate HIV risk appraisal in GBM. In order to achieve our target of zero new HIV infections by 2030, it will be essential to focus on enhancing psychological wellbeing in people at risk of HIV.

Predictors of Willingness to Diffuse PrEP Information within Ego-Centric Networks of Women Who Inject Drugs

Little is known about how social networks among women who inject drugs (WWID) can be leveraged to increase awareness about pre-exposure prophylaxis (PrEP). We tested the hypothesis that interpersonal characteristics influence willingness of WWID to communicate PrEP information with peers. Forty WWID ≥ 18 years completed social network surveys. Participants named on average 9.3 (SD = 3.3) network members, resulting in 375 unique relationships. WWID were willing to share PrEP information with 83% of network members. Participants had higher odds of willingness to share information within relationships when the network member was female, homeless and perceived to be at risk for HIV. Among relationships with family members and transactional sex clients, stronger emotional closeness was associated with higher odds of willingness to share information. Peer interventions where WWID share PrEP information with peers may be an efficient approach to increase PrEP awareness among this vulnerable population.

Reimaging an AIDS free generation: Examining youth and young adults' personal agency and its association with HIV testing

Exploring youth and young adult's agency may be a way to increase HIV testing and help end the HIV epidemic. We used data from the National Survey of Teens and Young Adults (15-24) on HIV/AIDS (N = 1,437). Data were collected from September 21-October 1, 2012. The sample included 748 girls and 689 boys; and the mean age is 20 years (SD: 3.02). Youth and young adults completed a 40-question survey on attitudes and knowledge about HIV. Using a multivariable logistic regression analysis, study findings suggest that focusing on protective health behaviors like the role youth can play in ending the epidemic and hearing about an AIDS-free generation were both associated with an increase in HIV testing. Our study finds that enhancing the role and influence of personal agency can inform HIV prevention and intervention programs that are specific to youth.

Social Networks, Trust, and Disaster-Risk Perceptions of Rural Residents in a Multi-Disaster Environment: Evidence from Sichuan, China

Individual perception of disaster risk is not only the product of individual factors, but also the product of social interactions. However, few studies have empirically explored the correlations between rural residents' flat social networks, trust in pyramidal channels, and disaster-risk perceptions. Taking Sichuan Province-a typical disaster-prone province in China-as an example and using data from 327 rural households in mountainous areas threatened by multiple disasters, this paper measured the level of participants' disaster-risk perception in the four dimensions of possibility, threat, self-efficacy, and response efficacy. Then, the ordinary least squares method was applied to probe the correlations between social networks, trust, and residents' disaster-risk perception. The results revealed four main findings. (1) Compared with scores relating to comprehensive disaster-risk perception, participants had lower perception scores relating to possibility and threat, and higher perception scores relating to self-efficacy and response efficacy. (2) The carrier characteristics of their social networks significantly affected rural residents' perceived levels of disaster risk, while the background characteristics did not. (3) Different dimensions of trust had distinct effects on rural residents' disaster-risk perceptions. (4) Compared with social network variables, trust was more closely related to the perceived level of disaster risks, which was especially reflected in the impact on self-efficacy, response efficacy, and comprehensive perception. The findings of this study deepen understanding of the relationship between social networks, trust, and disaster-risk perceptions of rural residents in mountainous areas threatened by multiple disasters, providing enlightenment for building resilient disaster-prevention systems in the community.

Contrasting the Perceived Severity of COVID-19 and HIV Infection in an Online Survey of Gay, Bisexual, and Other Men Who Have Sex With Men During the U.S. COVID-19 Epidemic

While there is evidence of variations in the risk perceptions of COVID-19 and that they are linked to both engagement in health-protective behaviors and poor mental health outcomes, there has been a lack of attention to how individuals perceive the risk of COVID-19 relative to other infectious diseases. This paper examines the relative perceptions of the severity of COVID-19 and HIV among a sample of U.S. gay, bisexual, and other men who have sex with men (GBMSMs). The "Love and Sex in the Time of COVID-19" survey was conducted online from April 2020 to May 2020. GBMSMs were recruited through paid banner advertisements featured on social networking platforms, resulting in a sample size of 696. The analysis considers differences in responses to two scales: the Perceived Severity of HIV Infection and the Perceived Severity of COVID-19 Infection. Participants perceived greater seriousness for HIV infection (mean 46.67, range 17-65) than for COVID-19 infection (mean 38.81, range 13-62). Some items reflecting more proximal impacts of infection (anxiety, loss of sleep, and impact on employment) were similar for HIV and COVID-19. Those aged over 25 and those who perceived higher prevalence of COVID-19 in the United States or their state were more likely to report COVID-19 as more severe than HIV. There is a need to develop nuanced public health messages for GBMSMs that convey the ongoing simultaneous health threats of both HIV and COVID-19.