Evidence of social network influence on multiple HIV risk behaviors and normative beliefs among young Tanzanian men

Abstract

Research on network-level influences on HIV risk behaviors among young men in sub-Saharan Africa is severely lacking. One significant gap in the literature that may provide direction for future research with this population is understanding the degree to which various HIV risk behaviors and normative beliefs cluster within men’s social networks. Such research may help us understand which HIV-related norms and behaviors have the greatest potential to be changed through social influence. Additionally, few network-based studies have described the structure of social networks of young men in sub-Saharan Africa. Understanding the structure of men’s peer networks may motivate future research examining the ways in which network structures shape the spread of information, adoption of norms, and diffusion of behaviors. We contribute to filling these gaps by using social network analysis and multilevel modeling to describe a unique dataset of mostly young men (n= 1,249 men and 242 women) nested within 59 urban social networks in Dar es Salaam, Tanzania. We examine the means, ranges, and clustering of men’s HIV-related normative beliefs and behaviors. Networks in this urban setting varied substantially in both composition and structure and a large proportion of men engaged in risky behaviors including inconsistent condom use, sexual partner concurrency, and intimate partner violence perpetration. We found significant clustering of normative beliefs and risk behaviors within these men’s social networks. Specifically, network membership explained between 5.78 and 7.17% of variance in men’s normative beliefs and between 1.93 and 15.79% of variance in risk behaviors. Our results suggest that social networks are important socialization sites for young men and may influence the adoption of norms and behaviors. We conclude by calling for more research on men’s social networks in Sub-Saharan Africa and map out several areas of future inquiry.

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“…Women exhibited different sexual risk behaviour when they were away from home, but men behaved the same regardless of whether they were mobile. In other settings, the amount of reported sexual partner concurrency was associated with being exposed to norms that support multiple partnerships (Carter et al, 2007; Mulawa et al, 2016; Yamanis et al, 2016). Common social norms that tolerate men having multiple concurrent partnerships, but condemn women who do so in a densely populated urban setting like Agbogbloshie could have a different influence on sexual behaviors – enabling men's concurrency, but driving women's concurrency behavior to distant places.…”

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“…Since the 1990s, researchers have used social network data (e.g., partner notification and contact tracing) to understand sexual behavior (58) and epidemic change for both HIV (59,60) and other sexually transmitted infections (61). More recently, two approaches have been used to capture sexual networks de novo: (i) focusing on quasi-closed communities, such as those confined to islands (62) or those with well-defined social networks where boundary specification is relatively straightforward (63,64); and (ii) attempting to gain saturated coverage of behaviorally or geographically defined groups (65-68). One powerful emerging use of social networks for understanding HIV transmission is its combination with phylogenetic data, thereby attempting to minimize the limitations of both data types (69)(70)(71), although there remain important ethical issues to consider in such detailed inference (72).…”

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