Accessing Social Networks With High Rates of Undiagnosed HIV Infection: The Social Networks Demonstration Project

Abstract

Objectives. We evaluated the use of social networks to reach persons with undiagnosed HIV infection in ethnic minority communities and link them to medical care and HIV prevention services. Methods. Nine community-based organizations in 7 cities received funding from the Centers for Disease Control and Prevention to enlist HIV-positive persons to refer others from their social, sexual, or drug-using networks for HIV testing; to provide HIV counseling, testing, and referral services; and to link HIV-positive and high-risk HIV-negative persons to appropriate medical care and prevention services. Results. From October 1, 2003, to December 31, 2005, 422 recruiters referred 3172 of their peers for HIV services, of whom 177 were determined to be HIV positive; 63% of those who were HIV-positive were successfully linked to medical care and prevention services. The HIV prevalence of 5.6% among those recruited in this project was significantly higher than the approximately 1% identified in other counseling, testing, and referral sites funded by the Centers for Disease Control and Prevention. Conclusions. This peer-driven approach is highly effective and can help programs identify persons with undiagnosed HIV infection in high-risk networks.

Sisters Empowered, Sisters Aware: Three Strategies to Recruit African American Women for HIV Testing

“…Social networks recruited the fewest number of women, yet this strategy was most likely to find women who engaged in very high-risk sex and drug use behaviors. These findings are similar to those reported by Kimbrough et al (2009), whose research showed that social networks were very effective in recruiting persons in high-risk networks. Published studies have reported similar findings that support using social networks to reach persons at high risk for HIV and other STDs (Halkitis et al, 2011;Rothenberg et al, 2000).…”

“…Women reached through social networks were most likely to report nonpermanent housing, unprotected sex with a male of known HIV risk, and drug use. Furthermore, the social network strategy is an especially important public health tool because the same social networks through which HIV infection occurs can be accessed for early detection and prevention of new infections (Adimora & Schoenbach, 2005;CDC, 2005;Kimbrough et al, 2009). A recent evaluation of multiple recruitment strategies to identify HIV-positive African American men who have sex with men (MSM) for HIV testing found social networks to be most effective, followed by partner services and alternate venues (Halkitis et al, 2011).…”

“…Alternate venue is a strategy that offers HIV CTR in nontraditional settings (such as substance abuse treatment facilities, prisons, churches, and mobile units) to identify persons at high risk who normally would not seek HIV testing in clinical settings Clark, Bowles, Song, & Heffelfinger, 2008;Cohen et al, 2005;Liang et al, 2005). The social network strategy involves enlisting HIV-positive and high-risk HIV-negative persons to identify and refer persons in their sexual, social, or drug-using networks for HIV testing (Adimora & Schoenbach, 2005;CDC, 2005;Kimbrough et al, 2009). To our knowledge, the effectiveness of these strategies in recruiting African American women for HIV testing has not previously been compared in large-scale trials.…”

Evaluation of the Relative Effectiveness of Three HIV Testing Strategies Targeting African American Men Who Have Sex with Men (MSM) in New York City

“…The literature suggests that the social networks strategy may be an effective method for identifying persons with undiagnosed sexually transmitted infections, including HIV [22][23][24][25]. In the social networks strategy, HIV testers and agency staff engage either HIV-positive individuals or those at high risk of seroconversion to become "recruiters."…”

Operational Research to Improve HIV Prevention in the United States

“…45 Many of the implementation challenges highlighted by these demonstration projects and other published studies examining various HIV testing strategies readily lend themselves to OR. 46,47 At a minimum, OR must identify optimal strategies for reaching high-risk persons to increase early detection, receipt of test results, and linkage to medical care. Effective strategies must be developed and disseminated to ensure that persons who receive preliminary test results also receive confirmatory results, to enhance partner services programs to identify new HIV-positive persons, and to strengthen the implementation of self-testing.…”