How do people alter their sexual behavior in the era of AIDS?
Individualistic models of behavioral change dominate the answer
to this question. However, these models are increasingly enlarged
by aspects of social networks that provide a person with opportunities
for health-related communication and interpersonal influence.
This paper explores the significance of social relationships to
two central stages within the process of sexual behavioral change:
the perceived risk to become HIV-infected by unprotected sexual
intercourse and the willingness to protect oneself against infection
either by sexual fidelity or by condom use. The empirical analyses
rest on data from the 'Kenyan Diffusion and Ideational Change
Project' (KDICP) that give information about AIDS-related, ego-centered
communication networks of Kenyan men and women. The respondents'
perceived risks as well as their intentions to protect themselves
against HIV-infection depend heavily on the prevailing perceptions
and favored protective methods within their personal communication
networks. The risk-perceptions both of men and women are shaped
by strong ties with relatives and friends. However, there are
gender-specific relationships that lead to the willingness for
protective behavior. Women tend to be influenced by strong ties
whereas men report more often - especially in the case of condom
use - on weak ties to distant acquaintances.
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Alexis
Ferrand - CNRS CLERSE Universite' de Lille The Building up of Opinions on the Quality of Care in Local Discussion Network |
Regulation of health systems implies controls on the quality
of care. Apart of formal controls organized by professional associations
or health organizations, patients, as clients, can play a role.
But it needs that they evaluate and judge various dimensions of
the quality of cares. And this is not simple for them due to the
asymmetry of knowledge and legitimacy. We demonstrate that informal
networks of discussion on health and cares exist often, not always
and that they allows formation of opinion.
An empirical research compares in two cities networks of discussion
about health among people. Items about opinions on the quality
of cares allow a description of references used by practitioners
and by people to evaluate care. We examine the effects of belonging
to various social milieus and to different local communities on
the types of networks build and the types of opinions they convey.
Doing so we propose new insights on the process by which quality
of care is controlled by informal networks.
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Alden S. Klovdahl - Australian
National University, School of Social Sciences, The Faculties Outbreak Networks: Concepts, Examples and Implications |
The purpose here is to discuss the concept of an outbreak network, to indicate how (and why) it differs from other conceptualizations of networks, to provide some examples of actual outbreak networks, and to highlight a range of implications of this concept.
Objectives: To explore the process of sex partnership formation
in high HIV prevalence neighborhoods among low income women who
use drugs and who are at risk of infection with HIV and other
sexually transmitted pathogens. Methods: As part of a pilot study,
in-depth, qualitative interviews were conducted with 28 women
who used drugs, recruited in New York City between March and November
2000.
Central to the research was an assessment of factors that motivated
and maintained sex partnerships.
Results: Participants were racially/ethnically diverse (29% black,
29% latina, 32% white, and 10% mixed race/ethnicity) and, on average,
30.5 years old. Most (79%) used heroin, crack (39%) or cocaine
(21%); 61% had injected drugs. Sex work was the most commonly
reported source of income (61%). However, the most common strategy
for long term material support was the initiation and maintenance
of sex partnerships. Sex partnership formation was influenced
by women's immediate need for material support and the opportunity
structure of available partners. Most women reported having partnerships
with older male partners able to supply needed resources (i.e.,
drugs, food, shelter, protection). Women supplied sex in exchange
for resources in these initially uniplex relationships. Many partnerships
went beyond their basis in material support and became emotionally
close, multiplex partnerships with strong ties of relatively long
duration. Unprotected sex was frequently reported in multiplex
relationships, with the exception of HIV serodiscordant relationships
in which the woman was HIV infected. Sex risk within uniplex relationships
also occurred, when women perceived that the provision of material
support had reached a threshold that required unprotected sex
in exchange.
Conclusions: Resource acquisition plays a significant role in
the formation of sex partnerships for women who use drugs. Disassortative
mixing patterns by age, high levels of sex partner concurrency
due to women's participation in sex work and multiple partnerships,
and the exchange of unprotected sex for material resources or
mutual participation in unprotected sex resulting from the development
of strong ties, all contribute to women's increased risk of acquiring,
and also of transmitting, infection in their sex partnerships.
OBJECTIVE: To determine the probability of hepatitis C virus
(HCV) transmission in the injecting partnerships of new injecting
drug users (IDUs).
METHODS: Between February 1999 and September 2000, new IDUs (injecting
for 6 years or less) in New York City between the ages of 18 and
30 were administered structured interviews and counseled and tested
for HCV. They were asked whether, in the last 30 days, they had
engaged in distributive equipment sharing (DES) (distributing
injecting equipment that they had used first to their injecting
network members) or receptive equipment sharing (RES) (receiving
injecting equipment used first by their injecting network members),
and if their injecting network members were infected with HCV.
RESULTS: 124 reported injecting networks (76.5% of 162 interviewed
and tested), 45 (36.3%) of whom were HCV seropositive (HCV+).
Of 246 injecting partnerships reported, HCV+ index new IDUs reported
83 (33.7%) and HCV seronegative (HCV-) index new IDUs reported
163 (66.3%). Among HCV+ indexes, 67 (80.7%) reported that their
partners were not known to be HCV infected and that DES occurred
in 21 (31.3%) of these partnerships; the transmission probability
was 25.3% of these partnerships. Among HCV- indexes, 21 (12.9%)
reported that their partners were HCV infected and that RES occurred
in 12 (57.1%) of these partnerships; the transmission probability
was 7.4% of these partnerships. HCV transmission behavior occurred
in 13.4% of all new IDU index HCV discordant partnerships (8.5%
from HCV+ indexes and 4.9% to HCV- indexes). This estimate of
the probability of HCV transmission is consistent with HCV seroconversion
rates reported in the literature.
CONCLUSIONS: There is a high probability of HCV transmission among
new IDUs and their injecting network members. The injecting partnership
mixing pattern among HCV discordant new IDUs, as well as the high
prevalence of HCV infection and of HCV transmission behaviors
contribute to the alarming incidence of HCV among new IDUs.
This paper examines how social and sexual networks affect the
risk of getting infected by sexually transmitted diseases (STDs).
Social networks can affect the risk in two ways: via information
or control. First, people get information about the risk of potential
partners as well as cultural norms about normal or safe sex through
social networks. Second, stakeholders, including primary sexual
partners, kin or close friends, exert control on who are appropriate
potential partners (and what is a proper relationship) through
their network ties. Based on the Chicago Health and Social Life
Survey (n=890) containing information on up to six social friends,
our paper supports the following four observations: 1) Social
network effects are found, even after controlling for individual
risk factors, such as number of sexual partners, drug injection,
gender, and race.
2) As the number of sexual partners increases, the network impact
of information strengthens. In addition, as the number of sexual
partners increases, control is more effective through third party
embeddedness.
3) Among people who had less than 13 sexual partners for life
time, people with no social friends are only 0.4 times as likely
to be infected as people with one or more social friends. This
advantage seems to be achieved through stronger dyadic control
rooted in the sexual partnership itself.
4) Among people who were very sexually active (13 or more partners
for life time), people with many (5 or 6) friends but weak ties
to them (talk less than once a day) are only 0.2 times as likely
to be infected as people with a few strong social ties. This protection
seems to arise from the flow of network information and third
party embeddedness.
