THE RELEVANCE OF DRUG INJECTORS SOCIAL AND RISK NETWORKS FOR UNDERSTANDING AND PREVENTING HIV-INFECTION

Focusing on the social environment as well as the individual should bo th enhance our understanding of HIV transmission and assist in the dev elopment of more effective prevention programs. Networks are an import ant aspect of drug injectors' social environment. We distinguish betwe en (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the peopl e among whom there are social interactions with a mutual orientation t o one another) as generators and disseminators of social influence. Th ese concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk net works converge with their social networks: 70% inject or share syringe s with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between d rug injectors and members of their risk network are often based on lon g-standing and multiplex relationships, such as those based on kinship , friendship, marital and sexual ties, and economic activity. In the f irst study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who in ject at shooting galleries are more likely than those who do not to re nt used syringes, borrow used syringes and inject with strangers. Sinc e the adoption of a network approach is relatively new, a number of is sues require further attention. These include: how to utilize social n etworks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and n on-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to stu dy drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyz ing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs.