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DeMarc A. Hickson, Leandro A. The role of sexual networks in the epidemiology of human immunodeficiency virus HIV among black men who have sex with men MSM is poorly understood. This suggests the need for culturally relevant HIV prevention efforts for black MSM that facilitate communication with sexual partners especially about risk reduction strategies, including preexposure prophylaxis. Of the incident HIV infections among black men in

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Social network size the total of named people who provided functional support to the participant as described below was the sole structural measure available in this data set. The primary outcomes of interest were two dichotomous variables describing whether the study participant had engaged in condomless receptive or insertive anal intercourse CRAI or CIAI with male sex partners primary, most recent, or otherwise classified who were reportedly living with HIV or who were of unknown HIV status in the past 6 months.

In addition to the associations noted above, people who reported CRAI also had a younger mean age Social network size measures were identical whether men did or did not report CIAI, with identical ranges 0—15medians 5and interquartile ranges 3.

In our opinion, one person providing support to an individual with a network of five people was more important than one person providing support in the network of an individual with a network of fifty people. Study participants answered whether contacts provided specific forms of social support i.

Subsequently, we fitted two mixed-effects logistic regression models to assess the relationship between each outcome i. To reflect this, we chose to use proportions rather than counts in our network statistical models. Study could yield insight on the ways social network support may impact HIV risk behavior, which could have implications on how to best utilize network support to disseminate intervention strategies such as PrEP or provide greater clarity on what types of peer networks may be at particularly elevated risk of having members acquire HIV. This secondary analysis used data collected between and from the HPTN study.

For example, having a higher percentage of people who provided social participation support was positively associated with the odds of reporting CIAI AOR: 1.

Despite these limitations, there are also several study strengths including the large sample size, the specific focus on black MSM, and the multisite study de that contributed to geographical diversity though study participants might not be representative of all black MSM in the United States. research has expanded their studies beyond just enacted support to include perceived support and have shown that perceived emotional and tangible support can contribute to increased regular condom usage in some MSM [ 20 ].

In addition, HIV-infected men participating in serosorting behavior could have a higher frequency of condomless sex, which could also explain our medical support finding [ 3536 ]. Therefore, our compare individual and network variables between those who did and did not participate in this type of condomless sex during the past 6-month time period.

Further research could explore how regional differences may contribute to sexual risk behavior in black MSM. There are some limitations to our study. As the source of social capital, social support, and behavioral norms, social networks can influence whether a man engages HIV risk behavior [ 12 ].

Aside from disciplinary preferences, there are methodological reasons for using proportions.

Social network support and decreased risk of seroconversion in black msm: of the brothers (hptn ) study

We also assumed that regardless of how expansive a respondent was they were likely to report networks similar in proportion to their real networks regardless of the overall of network members they report. Recent surveys of app users showed low uptake of pre-exposure prophylaxis PrEP despite high awareness of this biomedical intervention [ 3738 ]. Men who reported CRAI had a ificantly higher mean percentage of network members who would attend medical appointments The of the mixed-effects logistic regression models showed some similar associations when compared to bivariate analyses as seen in Table II.

Increasing age was associated with a lower likelihood of engaging in condomless receptive anal sex AOR: 0. Network composition measures quantified the amount of network contacts named in the network questionnaire that met certain relationship criteria.

Respondents would answer these questions and then provide the initials or nicknames of the people who met the stated criteria. This further supported our choice to use proportions in our analyses.

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However, there is limited research on how the social context or characteristics of social relationships affect protective or risk-taking behavior among black MSM, or whether there may be differential impact based on the availability of social support [ 3716 ]. Study participants who reported zero social network members were included in the repeated measure models, though there were no ificant differences between models that did or did not include these specific participants.

For example, one study observed that black MSM who had at least one member of their social network condone condomless sexual intercourse had an increased likelihood of engaging in high-risk sexual behavior [ 4 ], and the perception that male peers did not think condom use was highly important contributed to condomless anal sex risk in a sample of black and Latino MSM [ 2 ]. We explored how egocentric i. The next logical area of inquiry, given that HIV infection is often associated with social and sexual networks, is to examine the social context of sexual behavior through the lens of social networks.

In multilevel models MLM that incorporate network data e.

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Our study measures also lack granularity about network relationships, which limits our ability to examine behavioral dynamics and processes that underlie social network relationships. Although we used outcomes as repeated measures, we cannot assess causality directly between our study predictors and condomless sex, and missing predictor data at follow-up visits limited our ability to include time-varying independent variables in our models.

Examining the root causes of this disparity requires not only an exploration of epidemiologic factors that contribute to HIV seroconversion but also of socio-structural factors and individual behaviors that can increase exposure to HIV. For example, systemic factors such as reduced health care access including HIV prevention and caresocioeconomic challenges, and high levels of unemployment and incarceration have been cited as potential contributors to disproportionate HIV infection rates in black MSM [ 37 ].

We controlled for baseline predictors including reported age, level of education, frequently endorsed substance use including alcohol, marijuana, and stimulants [cocaine or methamphetamine] consumed in the past 6 months, study location site, HIV status biologically confirmedand structural and compositional network measures. Future research could expand on these by using detailed surveys that assess whether receiving support from specific individuals differentially influences risk behavior among black and other MSM of color. The most frequently used approaches to analyzing egocentric or personal network data use proportions to represent network composition [ 2930 ].

These findings are only associations; studies that collect longitudinal data would help us assess causal relationships. Furthermore, examining partner characteristics in greater detail could reveal how factors such as emotional closeness, frequency of contact, age differences, or geographic proximity could influence condomless sex risk and thereby shape behavioral interventions that focus on partner choice and negotiating safer sex practices.

Men could choose not to list any network members when answering the questionnaire. While social network composition had important links to condomless sex, it is important to mention those individual predictors that also showed ificant associations.

Social networks, comprised of the range of people with whom a person may interact friends, family members, sex partners [ 10 ] can play a ificant role in HIV transmission [ 3711 ].

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In line with research, stimulant use was associated with increased odds of condomless sex [ 4142 ]. This finding could be consistent with risk reduction strategies in which men who are HIV-infected engage in serosorting behavior while men who are HIV-uninfected are more likely to use condoms to avoid HIV infection [ 43 ]. Keith A. Wells and Nina T. Harawa provided study de feedback and research mentorship on this project. Men enrolled in the study received HIV and STI screening during their baseline assessment and two subsequent follow-up visits at the 6 month and 12 month measurement points.

Most social network studies of HIV risk behaviors focus on factors that increase the likelihood of risk behaviors. Further, the minority stress model describes how stress and stigma can contribute to compulsive sexual behavior and new HIV infections [ 14 ], though social support can potentially mitigate this stress [ 15 ]. Only 1. To assess whether there were ificant differences in network measurements between people who did or did not endorse specific sexual risk behaviors during their baseline assessments, we performed non-parametric tests that did not assume a normal distribution for each variable of interest depending on whether it was a continuous Wilcoxon-Mann-Whitney or categorical Kruskal Wallis measure.

Given the existing disparities in HIV infection among black MSM, there may be a role for targeting social network support in novel HIV prevention efforts for this population. Future research should examine the social processes that underlie these associations and explore ways that social support can affect HIV prevention efforts for black MSM. Disparities in HIV infection rates among black men remain severe in the United States despite evidence of a recent reduction in national incidence [ 1 ].

The second objective was to examine which network features might influence HIV-related risk behavior. Not surprisingly, findings have varied depending on the population studied and may be influenced by the context of the networks in which the study is conducted [ 21 ]. While men who endorsed CRAI had a slightly smaller social network size range 0—14 Social network for group sex dating Wilton to me who denied this sexual activity 0—15the medians 5 and interquartile ranges 3 were the same between these two groups.

In addition, the association between increasing age and a lower likelihood of reporting condomless receptive sex and the contrasting association between older age and increased odds of condomless insertive sex suggests that patterns of sexual risk behavior may change over the course of male sexual development [ 4445 ].

Steven Shoptaw reports grants from the National Institute on Mental Health during the conduct of the study and other support from Medicinova, Inc. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of each institutional research committee and with the Helsinki declaration and its later amendments or comparable ethical standards. An additional social network study determined that having peers who regularly went to school or were not heavy drinkers was associated with a decrease in sexual risk behavior in young MSM [ 19 ].

Indeed, most MLM texts would recommend that higher levels should for lower levels using summary measures i. We believed that count data for specific network composition questions support provision, for example were less effective at ing for variation in network size in statistical models and less effective at ing for individual differences in overall network size that lead the value of one person to differ from respondent to respondent though we have included a version of our analysis using count data in the Appendix.

The association between condomless anal sex and social support among black men who have sex with men (msm) in 6 u.s. cities: a study using data from the hiv prevention trials network brothers study (hptn )

Though our analyses are not multi-level, we believed that these conventions were appropriate and followed them in our analyses. Study site was also an important factor, with men located in Los Angeles having a higher propensity of reporting CRAI. Both of these factors could lead to a higher reporting of condomless sex compared to people with a relative paucity of medical support or social participation network members.

While our study findings continue to suggest the importance of individual factors in relation to sexual risk behavior, they also highlight important social network effects. Dating apps can potentially facilitate discussions about biomedical prevention and HIV viral suppression [ 40 ], and examining the presence of social support in GSN-established communities, especially given the possible overlap between online and in-person networks, may contribute to a greater understanding of condom usage or conversations about HIV risk among men and the sexual partners found through these applications.

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There may also be role expectations and power dynamics based on age in which older men are more likely to be an insertive anal sex partner compared to younger MSM [ 47 ]. It is also unclear how our findings may relate to geosocial-networking GSN smartphone applications appswhich have become increasingly popular among MSM populations. The first objective of this study was to explore how network structure and composition may vary between black MSM in the study who did and did not report recent episodes of condomless anal sex.

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However, some studies have focused on factors that decrease the likelihood of HIV seroconversion risk. Social network measures that assessed the availability of social support provided by network members showed ificant associations in the multivariate models.

Because each outcome was measured at both the initial assessment and subsequent follow-up visits, both variables were examined as repeated measures. However, researchers have also shown that examining individual risk behaviors such as substance use before or during sex use alone does not sufficiently explain HIV infection disparities in black MSM, noting comparative or lower rates of these activities when compared to non-black MSM [ 59 ].

The mean age was While there were no ificant differences in education, there were statistically ificant differences when comparing additional individual predictors at baseline by age, study location site, HIV status, and stimulant use as shown in Table I. A greater percentage of men reported CIAI In contrast, men who reported CIAI tended to be older mean age: There also appeared to be study site differences when examining CIAI, with a lower percentage of men However, there were no ificant study site associations for CRAI.

Ratings showing a higher percentage of network members who provided social participation and medical support were positively associated with reporting condomless sex. More reported social support was associated with increased condomless sex in black MSM when controlling for individual characteristics. Similarly, people with more medical network support members may have higher rates of STIs and require increased engagement with health care providers for treatment, which could be the result of increased condomless sex. We assessed how egocentric i.

Steven Shoptaw received support via the P30 MH grant.

Hypotheses for this site association include the possibilities that men recruited in Los Angeles were potentially engaging in more sexual risk behavior or more likely to disclose condomless receptive anal sex than men located at other sites. Study organizers also offered peer health navigators to help participants obtain needed medical or psychosocial services when they were identified at any point during the study participation timeline [ 22 ].

There were also ificant positive associations between stimulant use and condomless insertive and receptive anal sex.

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Social networks have been shown to influence HIV risk behavior; however, little is known about whether they affect the risk of HIV seroconversion.