A new HIV prevention network approach: Sociometric peer change agent selection

Abstract

Internationally, the Peer Change Agent (PCA) model is the most frequently used conceptual framework for HIV prevention. Change agents themselves can be more important than the messages they convey. PCA selection is operationalized via heterogeneous methods based upon individual-level attributes. A sociometric position selection strategy, however, could increase peer influence potency and halt transmission at key network locations. In this study, we selected candidate PCAs based upon relative sociometric bridging and centrality scores and assessed their attributes in comparison to one another and to existing peer educators. We focused upon an emerging HIV epidemic among men who have sex with men in Southern India in 2011. PCAs selected based on their bridging score were more likely to be innovators when compared to other centrally-located PCAs, to PCAs located on the periphery, and to existing peer educators. We also found that sociodemographic attributes and risk behaviors were similar across all candidate PCAs, but risk behaviors of existing peer educators differed. Existing peer educators were more likely to engage in higher risk behavior such as receiving money for sex when compared to sociometrically selected peer changes agents. These existing peer educators were also more likely to exhibit leadership qualities within the overall network; they were, however, just as likely as other non-trained candidate peer change agents to report important HIV intravention behavior (encouraging condoms within their network). The importance of identifying bridges who may be able to diffuse innovation more effectively within high risk HIV networks is especially critical given recent efficacy data from novel HIV prevention interventions such as pre-exposure prophylaxis. Moreover, while existing peer educators were more likely to be leaders in our analysis, using peer educators with high risk behavior may have limited utility in enacting behavior change among sex worker peers or male clients in the network.

Evidence of social network influence on multiple HIV risk behaviors and normative beliefs among young Tanzanian men

“…The role of network centralization in shaping the social control of network members should also be examined in future research. These findings could further support and inform the development of interventions that aim to leverage specific aspects of normative power of individuals who hold special roles within their networks (Schneider, Zhou, & Laumann, 2015). …”

Social Media Use and HIV-Related Risk Behaviors in Young Black and Latino Gay and Bi Men and Transgender Individuals in New York City: Implications for Online Interventions

“…Focusing on social media elements likely to exist in the future (e.g., leveraging online social networks 45,46 or global positioning system (GPS)-based technology 47 ), interventions are more likely to remain relevant. 48 Furthermore, tailoring social media-based interventions to both the specific target population and individual behaviors (e.g., online outreach messages specific to young Black MSM engaged in exchange sex) may hold the greatest potential for efficacy; methodologies for development and evaluation are needed though to develop these types of tailored interventions that are also easily scalable.…”

Sociometric network structure and its association with methamphetamine use norms among homeless youth

“…Understanding the structural network mechanisms that influence perception of norms would elucidate important information regarding how network interventions should be tailored and, more importantly, guide the selection of peer change agents in these networks (Barrington et al, 2009; Schneider et al, 2015). …”

“…In particular, network structure can be used to identify potential routes for norm diffusion and locate targets for prevention with the ultimate goal of modifying behavior. For example, in the context of both HIV and substance use prevention, interventions have typically relied on the popular opinion leader model (Kelly et al, 1991), which uses influential people (or those with social status) in communities to serve as peer change agents to diffuse safer norms into high-risk groups (Schneider et al, 2015). …”