Kipke; Network correlates of sexual health advice seeking and substance use among members of the Los Angeles House and Ball communities, Health Education ResearchVolume 29, Issue 2, 1 AprilPages —, https: House and Ball communities HBCsrepresent a prime context for human immunodeficiency virus prevention with African American young men who have sex with men and transgender persons.
Participants were recruited using venue-based sampling and asked to report on sexual health advice seeking, alcohol use and illicit substance use. Participants were more likely to seek sexual health advice from social support network members compared with sexual network members [odds ratio OR: HBC members were more likely to get drunk OR: Health promotion programs tailored for the HBC should encourage open communication regarding sexual health; these interventions must include Sexual health support networks for black about the role of substance use in sexual risk taking.
African American men have the highest incidence of human immunodeficiency virus HIV when compared with all other racial and ethnic groups and an incidence rate almost eight times higher than their White counterparts [ 1 ]. African American MSM
Sexual health support networks for black more likely to choose partners of the same race compared with partners of other races, which may put them at greater risk for HIV transmission due to higher HIV prevalence rates among African American men compared with men in all other racial and ethnic groups [ 12 ].
A recent study by VanDevanter et al. Social networks refer to a set of individuals connected by social bonds e. The social network principal of homophily posits that individuals will cluster together in networks based on similar behavioral characteristics [ 20 ] and previous studies with other vulnerable youth, including YMSM, have demonstrated that individuals with more risk taking in their social networks are more likely to engage in risk behavior themselves [ 2122 ].
In addition, studies with other populations at high risk for HIV infection have found that substance use is more likely to occur among members of sexual networks compared with social support networkswhich has significant implications for HIV intervention delivery [ 23 ].
Hart and Peterson [ 24 ] found that unsupportive peer norms about condom use were associated with unprotected anal intercourse in a large sample of AAYMSM ages 18—25, which is consistent with studies of older AAYMSM [ 25 ] and African American adolescents, in general [ 26 ]. This study sought to: The overarching goal of this analysis was to understand whether health protective i.
Two hundred sixty-three participants were recruited at 12 survey events between February and January Individuals were recruited regardless of gender, sexual identity or behavior in order to represent the entire community of individuals attending Balls in Los Angeles. HBC members were eligible to participate if they attended an event during the study time period and had not previously participated in the research survey.
Venue selection and participant recruitment were adapted for the target community. Recruitment venues were categorized into three types: Balls, House meetings and community events. Events and venues included in the sampling frame had at least a 2-h time period with an Sexual health support networks for black yield of at least four HBC members. Sampling periods typically occurred during late-night or early-morning hours. Study staff approached persons who entered the designated event or venue to assess eligibility.
Eligible persons were escorted to the private survey booths to complete the data collection activity. All participants provided written informed consent. For persons younger than 18, a waiver of parental permission was obtained. More in-depth information regarding study methodology is available elsewhere [ 3940 ].
Past day alcohol misuse was based on a series of items assessing frequency and intensity of alcohol use in the past 30 days. Egocentric networks were generated by asking participants to name up to five people in their lives who provided emotional support i. Respondents then named up to five additional people with whom they had had sex in the past 3 months and indicated whether any of the previously nominated network members were also sexual partners in the past 3 months for a total of 10 possible network members.
Any network members with whom the participant had had sex in the past 3 months were classified as sexual network members; all others were classified as social support network members.
Univariate and bivariate analyses were conducted in the Statistical Package Sexual health support networks for black the Social Sciences, Version For all three outcomes, bivariate logistic regression analyses were conducted with an initial set of variables at the participant level i. Sexual health support networks for black that were statistically significantly associated with outcomes at the bivariate level were included in multivariate models.
Final models presented here only included those variables that were statistically significant in the multivariate analyses.
Intraclass correlations between the ego and alter levels are presented by outcome in the corresponding tables. Descriptive statistics for participants are summarized in Table I. Among the participants surveyed, a total of social support network and sexual network members were nominated Table II.
Network characteristics were also correlated with the likelihood the participant reported having gotten drunk with a given network Sexual health support networks for black in the past 3 months Table IV. This study is the first of its kind to examine the egocentric network characteristics of HBC members. These results are somewhat surprising given previous writings about HBCs, which describe high levels of alienation from families of origin as a primary motivation for joining HBCs [ 3435 ].
Our findings indicate substantial connection to family of origin and evidence that HBC members derive significant social support from these relationships. Continued connection to family has been shown beneficial in protecting high-risk youth against negative health outcomes [ 42 ] and has been called on as a useful approach for reducing HIV among YMSM [ 43 ]. Consideration Sexual health support networks for black family-based interventions for HBC members warrants further attention.
Comparisons between social support network versus sexual network conducted using multilevel bivariate logistic regression. Our findings suggest substantial differences between social and sexual networks of HBC members in demographic characteristics, HBC affiliation and risk behavior. Social support network members had known respondents longer, provided higher levels of social and tangible support, had greater influence on respondents, and communicated with respondents more frequently than sexual network members.
Sexual network members were more likely to get drunk with participants and to use illicit substances. In addition, greater percentages of social support network members were affiliated with the HBC compared with sexual network members.
Previous studies of HBCs elsewhere have demonstrated that these communities provide opportunities for both risk taking and social support [ 34—37 ]. Further information regarding where HBC members meet potential sexual partners and the nature of those sexual encounters are necessary to better promote sexual health with this population.
Results from this study may have significant implications for HIV transmission both within the HBC, the broader African American community, and beyond. Because AAYMSM and transgender persons have been described as difficult-to-reach [ 29—30 ], prevention professionals would be wise to consider network-based intervention strategies, which are designed for diffusion through sexual networks [ ].
This would enable them to reach out to and to promote safer sexual behaviors among HBC members and their partners, presenting a promising way to reduce HIV incidence within the HBC and the larger African American community. Overall, social support network members were more likely to be sought out for sexual health advice compared with sexual network members. Combined with information on the duration of social support network relationships and the frequency of communication between participants and their social support network members, these results indicate the potential for sexual health interventions implemented through social support networks.
A study by Mutchler and McDavitt [ 28 ] examined sexual health communication among young gay men and found that although peer communication regarding sexual behavior was intended to promote safer sex behavior, inaccurate assumptions about HIV risk assessment may have actually put young gay men at higher risk for HIV. Although it might be counter-intuitive that participants would be more likely to seek sexual health advice from network members who they have known for shorter durations, it is important to take into account that social network alters included family members e.
Little is known about the content of the sexual health advice exchanged between participants Sexual health support networks for black HBC members; more in-depth information about sexual communication between HBC members and members of their social support networks is warranted.
Furthermore, it is unclear whether willingness to seek out sexual health advice may actually result in following the advice received, which should also be addressed in future research. In addition, those in our study who had participated in an HIV prevention program previously were more likely to seek sexual health advice from network members. With cross-sectional data it is impossible to determine the direction of this association. Although it is possible that those who participate in HIV prevention are naturally more open to discussing sexual behavior, it is also possible that previous engagement with HIV prevention services has prompted greater willingness to engage in sexual health advice seeking.
More information is needed on community norms regarding sexual health advice seeking within and beyond "Sexual health support networks for black" HBC community. Alcohol use with the nominating participant and illicit substance use among network members were both associated with individual behavior and House membership.
Participants who reported frequent or binge drinking were more likely to get drunk with network members than non-frequent or light users, and those who were illicit substance users themselves Sexual health support networks for black more likely to have other illicit substance users in their "Sexual health support networks for black." These findings are consistent with a large body of social network literature, which indicates that higher risk taking among network members is associated with higher risk taking among the participant himself [ 2122 ].
Homophily, the grouping of like individuals in networks, has been attributed to both selection and social influence. Individuals who use substances may seek out other substance users selection or may be encouraged to use substances through norming of use in social networks social influence.
"Sexual health support networks for black" it is impossible to determine from cross-sectional data whether our findings are attributable to influence or selection, our results of high levels of getting drunk within networks and illicit substance use among network members warrant additional attention.
Further research should be conducted into the motivations for substance use among HBC members and community norms related to substance use within HBCs. Prevention interventions targeted at reducing sexual risk behavior in the HBC should include information on substance use. As our results have shown, sexual network members were more likely to get drunk with participants and use illicit substances than social support network members.
In addition, participants were more likely to get drunk with others who were members of a House and House members were more likely to use illicit substances compared with non-House members. Given that substance use has been associated with greater sexual risk behaviors among YMSM in general [ 45—47 ] and AAYMSM specifically [ 16 ], additional work should be conducted to further understand the role of substance use in sexual relationships among HBC members.
HBC community leaders may be amenable to structural changes in Balls and other Sexual health support networks for black events that deter substance use in these venues. This study has limitations, which should be taken into account when interpreting the results. This study focused exclusively on the Los Angeles HBC, which limits its generalizability to HBC throughout the United States, especially because demographic characteristics of our sample differed from previously studied HBCs in other cities [ 3235 ].
All data were based on self-report, which may be subject to social desirability bias. Although use of ACASI data collection techniques should reduce social desirability bias [ 48 ], it is difficult to know whether this occurred in "Sexual health support networks for black" study.
In order to reduce respondent burden we limited the network inventory to 10 nominations, which may have artificially truncated the networks of some participants.
Finally, we did not collect data on the type of sex HBC members engaged in with sexual network members or information on condom use within Sexual health support networks for black network partnerships.
Without this information, it was impossible to determine the extent to which HBC members engaged in risky sexual behavior. Despite these limitations, this study has significant implications for HIV prevention within the HBC and more broadly. First, given that a large percentage of social support networks comprised family members, it seems prudent to explore the feasibility
Sexual health support networks for black family-based HIV prevention with this population.
Family-based intervention programs for diverse populations of young people have been effective in reducing substance use and sexual risk behavior previously [ 49—51 ].
Others have called for family-based HIV prevention for YMSM [ 43 ] given the important role of parents in the lives of gay youth [ 52 ]. However, further research on the acceptability of family-based interventions must be tempered by the recognition that HBC community members may have been rejected by families of origin, as suggested by prior work [ 3235 ].
Consistent with existing research with HBC communities elsewhere, our findings clearly point to the urgent need to develop effective interventions for this population. One social network-based intervention that has been used with varying success, depending on the fidelity of its implementation, is the popular opinion leader POL model [ 53 ].