A Social Network Approach to Demonstrate the Diffusion and Change Process of Intervention From Peer Health Advocates to the Drug Using Community

Abstract

Project RAP (Risk Avoidance Partnership) trained 112 active drug users to become peer health advocates (PHAs). Six months after baseline survey (Nbl = 522), 91.6% of PHAs and 56.6% of community drug users adopted the RAP innovation of giving peer intervention, and 59.5% of all participants (N6m = 367) were exposed to RAP innovation. Sociometric network analysis shows that adoption of and exposure to RAP innovation was associated with proximity to a PHA or a highly active interventionist (HAI), being directly linked to multiple PHAs/HAIs, and being located in a network sector where multiple PHAs/HAIs were clustered. RAP innovation has diffused into the Hartford drug-using community.

Peer helpers’ struggles to care for “others” who inject drugs

“…In keeping with their formal mandate as needle-distribution agents, natural helpers began by describing how they strive to embed harm reduction practices within the social field of selfdirected drug administration. Although the provision of material resources such as syringes and cookers is obviously a necessary condition, the uptake of harm reduction practice ultimately depends on the persuasive power of natural helpers themselves (Latkin et al, 2013;Li, Borgatti, Clair, & Dickson-Gomez, 2012;Weeks et al, 2006, p. 9). As Latkin and Knowlton (2005, p.…”

Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review

“…For SNIs focused on HIV prevention (k=11), peer educators or leaders recruited participants from their drug using and/or sexual social networks. Of these eleven, there were six studies (56%), where the both the peer and their recruited social network members, had equal participation in the study, and everyone received the intervention (43, 44, 46, 58, 78, 80). In the remaining five studies (44%), network members did not participate in the intervention directly, but were recipients of diffusion of HIV prevention information from peers and participated in the baseline and/or follow-up assessments (54, 66, 68, 73, 87).…”

“…In the remaining three studies (49, 67, 78), peers played the role of health advocates or health buddies supporting each other to improve adherence to ART and retention in HIV care (Table 1). The HIV prevention interventions in these studies included: providing educational information on practicing and promoting safe sexual and drug using behaviors with social network members throughout the study period (43, 44, 46, 58, 80); distribution of materials such as bleach, condoms, and needles in the community (44, 46, 80); and hands-on experimental sessions on HIV prevention education of 90–120 minutes over a period of 2 to 4 weeks.…”

“…All the nine HIV prevention studies that included controls showed substantial improvement in more than one HIV-risk reduction behavior (sharing syringes, sharing cookers and filters, frequency of injection, unprotected sex) and HIV education communication among social networks comparing control and intervention conditions (43, 44, 46, 54, 58, 66, 68, 78, 80). Four studies documented that SNIs, compared to the control conditions, were successful in recruiting a higher proportion of hard to reach at-risk population, which is the first step of any HIV prevention or treatment programs (43, 44, 58, 80) (Table 3).…”

Participant and Staff Experiences in a Peer-Delivered HIV Intervention with Injection Drug Users

“…Previous studies have demonstrated the efficacy of peer-delivered interventions to diffuse risk reduction information through networks of active drug users, resulting in significant reduction in illicit drug use and drug-related risk behaviors among trained peers and their untrained drug-using network members (Weeks et al, 2009a, 2009b; Li et al, 2012). Exposure to peer-delivered interventions has been associated in both groups with entry into drug abuse treatment, improved attitudes toward risk reduction and health promotion, and increased empowerment and engagement in risk/harm reduction efforts among peers (Convey et al, 2010; Dickson-Gomez et al, 2006).…”