Social psychological dynamics of enhanced HIV risk reduction among peer interventionists

Abstract

The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug-using networks in the Risk Avoidance Partnership (RAP) project. Results suggest three mutually reinforcing social psychological processes that motivate PHAs to provide HIV prevention intervention to their peers and to reduce their own risk behaviors: development of a prosocial identity, positive social reinforcement from drug users and community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy. These processes directly influence peer interventionists’ motivation and efficacy to continue giving intervention to their peers, and to reduce their HIV risk behaviors. The authors discuss implications of the model for continued research on effective HIV prevention in high-risk groups.

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

“…Sociometric network analysis revealed that Contacts’ exposure to RAP innovation (i.e., receiving peer intervention) was clearly associated with proximity to any PHA/HAI, being directly link to multiple PHAs/HAIs, and being located in a network sector where multiple PHAs/HAIs were clustered. The fact that PHAs had a stronger impact on Contacts than HAIs supports our prior ethnographic findings that PHAs had established a positive admirable identity and image in the community (Convey et al, 2010; Dickson-Gomez, Weeks, Li, & Convey, 2011, Dickson-Gomez, et al, 2006). The role model PHAs presented motivated Contacts to adopt the innovation of peer intervention delivery and modeling, and the adoption of RAP innovation among Contacts further diffused and resulted in behavior norm change among the community of drug users.…”

“…However, sustained peer intervention delivery and modeling among PHAs was not only motivated and supported by monthly project CAG meetings, but also by observing other very active peer interventionists’ actions, though PHAs might not have been fully aware of the latter influence. Qualitative analyses also suggested that PHAs’ behavior change mechanisms could be the function of their altruism (Convey, et al, 2010), the development of their pro-social roles, positive social reinforcement from drug users and other community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy (Dickson-Gomez et al, 2011). …”

Peer-Education Intervention to Reduce Injection Risk Behaviors Benefits High-Risk Young Injection Drug Users: A Latent Transition Analysis of the CIDUS 3/DUIT Study

“…Individuals in these lower risk classes were likely to switch to low-risk behavior regardless of the intervention, with about two-thirds transitioning to the low-risk class. Theoretical explanations of risk reduction among peer interventionists have included cognitive consistency, social identity theory, and social reinforcement [27, 41–43]. Developing a pro-social identity, positive social reinforcement from community members, and cognitive dissonance associated with continued risk behavior, can influence motivation and self-efficacy for risk reduction [41].…”

“…Theoretical explanations of risk reduction among peer interventionists have included cognitive consistency, social identity theory, and social reinforcement [27, 41–43]. Developing a pro-social identity, positive social reinforcement from community members, and cognitive dissonance associated with continued risk behavior, can influence motivation and self-efficacy for risk reduction [41]. For IDUs with high-risk behavior, the PEI may provide the social-cognitive stimulus they need to move to a higher level of motivational readiness for behavior change [44, 45]—to move from contemplation to preparation, and from preparation to action.…”

Translation of the Risk Avoidance Partnership (RAP) for Implementation in Outpatient Drug Treatment Clinics

“…RAP is an evidence-based program originally tested in a community setting with active drug users trained as Peer Health Advocates (PHAs). Trained PHAs implemented a semi-structured peer intervention promoting risk/harm reduction of HIV, hepatitis, STI, and TB with their drug-using peers, sex partners, and others in their networks and neighborhoods (Dickson-Gomez et al 2011; Li et al 2012; Weeks et al 2009; Weeks et al 2006; Weeks et al 2009). Thus, RAP is a two-tiered intervention: the PHA Training Curriculum (Weeks et al 2004) is the first (staff-delivered) tier; the RAP Peer-delivered Intervention is the second (PHA-delivered) tier.…”