"Friendships are a big part of it": social relationships, social distance, and HIV risks

Co-use among confidants: An examination of polysubstance use and personal relationships in southeastern Nebraska

This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of "supportive" social contacts and "risky" social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.

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

Roughly 1 in 7 people living with HIV in the United States is unaware of their sero-status, signaling that individuals may be underestimating their risk for HIV. Few studies have examined the effect of socio-structural and socio-cognitive factors on HIV risk perceptions. This analysis identifies individual, interpersonal and network influences on HIV risk perceptions among high-risk heterosexuals. Data come from the Colorado Springs study, a CDC-funded project focused on HIV transmission among high-risk heterosexuals. Using social network data, analyses were first conducted at the individual-level using a partial proportional odds regression to identify predictors of self-perceived HIV risk. Next, multivariate binary logistic regression using GEE was used to examine  predictors of perceptions of network member's  HIV risk. Interpersonal characteristics such as perceptions of network member's HIV risk, racial homophily, and engagement in multiplexity (co-occurrence of drug-use, needle sharing and sex within relationships) were significantly associated with respondents' self-perceived HIV risk. Factors associated with perceptions of network member's HIV risk include self-perceived HIV risk, emotional closeness within relationships, and density of drug ties. Analyses found HIV risk perception is the product of not only individual-level factors, but also interpersonal and social network processes. We also found a reciprocal relationship between individuals' perceptions of their own risk and the risk of their associates/network members. Findings highlight the need for understanding risk perception as a function of interpersonal relationships, social constructions, including socio-cognitive processes.

Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men

The study aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or their attitudes to highly active antiretroviral treatments. Any unprotected anal intercourse (UAI) with casual partners was used as the sexual-risk indicator. The study enrolled 261 MSM. There were no significant differences between beliefs, attitudes and perceptions about HIV/AIDS, knowledge of post-exposure prophylaxis (PEP) or exposure to the HIV/AIDS epidemic among those who had had UAI with casual partners and those that had not (P>0.12). Those who considered that low levels of viral load and withdrawing before ejaculation reduced the risk of HIV transmission were significantly more likely to have had UAI with a casual partner (P=0.03). Only a minority of MSM engaging in UAI were optimistic about antiretroviral therapy. The study participants were in general pessimistic about life with HIV/AIDS despite their risk-taking sexual behaviour.

Pathways to sexual risk reduction: Gender differences and strategies for intervention

Using the AIDS risk reduction model as our conceptual framework and structural equation modeling as our analytic tool, we tested psychosocial antecedents of sexual risk reduction among heterosexually active men and women who use illegal drugs. With baseline sexual risk behavior controlled, stronger commitment to safer sex predicted less sexual risk behavior for both men and women. For men but not women, greater AIDS knowledge predicted safer sex commitment. For women but not men, higher self-efficacy predicted stronger commitment to safer sex, and peer norms favoring sexual risk reduction predicted higher self-efficacy. Intervention for men should focus on increasing safer sex commitment and AIDS knowledge. Intervention for women should promote safer sex commitment by raising self-efficacy for sexual risk reduction.

The role of personal contact with HIV-infected people in explaining urban, African American preadolescents' attitudes toward peers with HIV/AIDS

This article presents the results of a study aimed at describing African American youths' attitudes toward peers with HIV/AIDS and identifying correlates of these attitudes based on the contact theory. Baseline data from a sample of African American, urban mothers and their youth (n = 197) participating in a family-based HIV prevention program were analyzed. In support of contact theory, preadolescents' close relationship to persons infected with HIV/AIDS was highly related to their attitudes. However, no relationship was found between maternal attitudes or communication variables and youth attitudes. The implications of youths' experience with persons with HIV/AIDS as part of prevention programming are discussed.