SHINE Affiliates: John Schneider (PI), Dexter Voisin (PI), Alida Bouris (Co-I)
Project Summary/Abstract: This goal of this project is to refine and pilot test a flexible Network Supported Engagement in Care (NSEC) intervention that recruits and motivates one or more organic social support network members of recently HIV diagnosed young black men who have sex with men (YBMSM) to improve engagement in HIV primary care. While data exist for young black men on factors related to HIV acquisition and antiretroviral adherence, there is a lack of empirically tested interventions on a key intermediate step in the treatment cascade: retention in care. Several existing strategies seek to address challenges to retention in care, including peer support groups, case management programs, multi-modal peer outreach, and peer health navigation. These efforts all share a common ingredient - newly created network members – a traditional public health intervention approach. What is often missing in these strategies is a coordinated attempt to harness organic social support networks that naturally exist. Our use of “organic” refers to an endogenous existing network; and can be contrasted to newly generated support persons such as assigned peer navigators or lay health workers. The concept of organic social support as a powerful force in the health of HIV infected persons is well documented; but has been underutilized to retain YBMSM newly diagnosed with HIV in care. Living with HIV requires persistent, deep and ongoing social support; support often only available from existing confidants - friends, partners, kin and other individuals – with whom one might share personal information with and be influenced by. Flexibility of NSEC ensures that a support confidant (SC) is selected based upon factors such as providing a supportive function (e.g., emotional support) as opposed to their status (e.g., mother). Such SCs are likely important not only to retention in care, but also to sustained health maintenance, risk reduction behavior maintenance and long-term adherence to antiretrovirals (ARVs). We have developed a theoretically and conceptually grounded NSEC brief intervention that 1) utilizes social support network visualization and network theory to help YBMSM safely identify a SC to engage in retention in care activities; 2) uses an Information-Motivation-Behavioral Skills (IMB) Model targeted at the SC to activate and maintain HIV-specific social support within the dyad; and 3) uses a linked HIV-specific social support conceptual model to then drive appointment adherence among the index YBMSM. Our primary aims are to: 1) Refine intervention protocol, materials and assessments by 1) coordinating intervention components that activate the SC through individual and dyadic sessions; and 2) systemizing social support of the index via interactive mini-booster cell-phone/text sessions directed at both members of the dyad; and 2) Pilot test the feasibility and initial efficacy (lower missed visit proportion (MVP) of the NSEC intervention versus standard linkage to care at 3- and 12- months post randomization among a sample of 94 YBMSM, ages 16-29. Secondary outcomes to be assessed include dyadic closeness, self-efficacy and social support, antiretroviral adherence and HIV viral load.
SHINE Affiliates: Dexter Voisin (PI)
Project Summary/Abstract: African American youth, ages 13 to 24, comprise 15 percent of the adolescent population, but account for approximately 65 percent of reported adolescent HIV cases (Centers for Disease Control, 2011). While factors like early sexual début (i.e., having sex before age 14) and a higher number of sexual partners may in part account for such disparities among this group, recent research has begun to illuminate the pathways to such risk behaviors. Community violence exposure (CVE) is widely defined as the frequent and continual exposure to random violence, involving guns and drugs in the community and includes witnessing, knowing victims of such acts and being victimized. A growing body of research documents that CVE is related to risky sexual behaviors. More importantly, emerging research shows that this relationship is mediated by several risk pathways. For instance, CVE has been shown to be related to low school success, mediated by psychological distress (e.g., PTSD symptoms, and increased internalizing and externalizing behaviors), and low school achievement is related to HIV-related risk behaviors, mediated by negative peer norms.
Given the long term trauma associated with CVE on individuals and the vulnerability of youth, it is not surprising that the majority of existing research has focused on child and adolescent socio-emotional and behavioral risk outcomes associated with such exposures. However, in neighborhoods where youth are exposed to high rates of CVE, parental figures are also confronted by similar rates of exposures. Unfortunately, there are no studies that have focused primarily on the effects of CVE on youth HIV risk behaviors, and how such exposures may also affect parenting behaviors and subsequent HIV-related sexual risk behaviors among youth. The specific aims of the pilot project are:
Aim 1: To investigate parenting factors that may moderate the pathways linking community violence exposure (CVE) and risky sexual behaviors among urban African American adolescents (grades 8th and 9th) (4 focus groups comprised of parental figures).
Aim 2: To quantitatively examine factors that may mediate and moderate the pathways linking CVE and HIV-related sexual risk behaviors that were clarified from focus group data (N= 105 matched pairs of adolescents and their guardians).
Aim 3: Based on the findings, develop an R01 proposal aimed at a rigorous longitudinal study, focused on the factors that mediate and moderate the relationships between CVE and increased HIV sexual risk behaviors among urban African American youth.
The proposed study will use a cross-sectional design, first using four focus groups of parental figures, then a self-administered survey targeting 105 matched pairs of adolescents and their adult guardians. Findings will increase our understanding of key factors associated with HIV risk behaviors, especially the moderating effects of parenting given CVE. These findings will provide preliminary data for a completive R01 application, that would not only help us specify the potential pathways among a cohort of middle school African American students who we will follow during transition to high school to determine how changing levels of CVE, parental practices and peer networks may influence risky sex. In addition, this pilot study will help us to demonstrate the feasibility for the RO1 study and clarify and refine our measures as well as our recruitment strategies and methods for a 5 year longitudinal study.
SHINE Affiliates: John Schneider (PI), Stuart Michaels (Co-), Dexter Voisin (Co-I)
Project Summary/Abstract: This research program grant application (R01) requests funds to conduct basic investigation of how social networks affect risk and risk reduction practices longitudinally in the context of sex-drug use within a community-based sample of younger Black men (16-29) who have sex with men (YBMSM) in order to identify critical points for intervention to reduce HIV transmission. YBMSM are embedded within heterogeneous Black communities. From the perspective of an individual YBMSM, his social network often include close confidants such as primary partners, relatives and friends who may exert supportive or antagonistic influences on his behavior and choice of partner(s). Many of these friends may crossover between the non-sexual and sexual components of one’s network over time. Additionally, numerous other structures and institutions such as the ballroom community, detention centers/jails and internet social networking sites shape YBMSM networks and norms. How YBMSM are positioned within these rich and dynamic social environments and the considerable influence their social networks have on sex partner selection, sexual/drug related practices and risk-reduction behavior with specific partners has only recently begun to be explored.
Our analytic approach focuses on components of the Auerbach ‘social drivers’ model applied to YBMSM, with particular attention to two components that this team is well positioned to study: norms and networks. These factors shape individuals’ behaviors and practices modulated by situational factors such as sex-drug use. Based upon our preliminary work, we found that 1) dyadic mixing by risk behaviors (UAI, sex-drug use, group sex); 2) influences from social network members; and 3) composition of non-sexual social networks are associated with risk and biomedical prevention interventions in cross-sectional analyses of YBMSM. Thus far however, causal associations between networks and other ‘social drivers’ of HIV infection among BMSM, have been elusive. Accordingly, utilizing a 3 wave longitudinal cohort approach we aim to: 1) Describe the dynamics of social networks among YBMSM ages 16-29, and estimate the relationships between specific network attributes (e.g., confidant composition and component size) and subsequent risk/risk reduction behaviors, including their interaction with various social structures and institutions; 2) Examine the relationships between social networks, norms, risk/risk reduction practices and HIV/STI infection over time among this sample and their extended networks; 3) Determine the extent to which situational factors such as sex-drug use mediates the relationship between social network characteristics, norms and risk/risk reduction practices over time; and 4) Explore how learning that one is HIV positive affects social networks, norms and risk/risk reduction practices. This research is a necessary step in the development of scientifically-based network interventions that can complement combination interventions targeted to diverse YBMSM groups and their extended networks.