Social and sexual networks of newly diagnosed people living with HIV: a qualitative social network analysis.

Abstract

Background: A better understanding of HIV transmission dynamics is needed to further reduce the number of new HIV diagnoses in Belgium. As environmental and social context play an important role in explaining HIV acquisition despite the availability of effective HIV prevention, this study investigated how social and sexual networks may have influenced HIV prevention and risk behavior among a group of people newly diagnosed with HIV, including their perceptions of how they acquired HIV and their ability to disclose their HIV status.

Methods: We used an ego-centric social network approach, generating sociograms of social and sexual networks through in-depth interviews with 20 participants newly diagnosed with HIV.

Results: Many participants reported a considerable overlap between their social and sexual networks. Friends, family members, regular sex partners and HIV physicians were placed closest to the ego on the sociogram. Self-identified gay men did not consider their casual sex partners as emotionally close enough to be included in the sociogram, despite these partners often being participants' primary source of information about sexual health. Self-identified heterosexual and bisexual men who have sex with men (MSM) had more diverse and separated networks, and often had not considered themselves at risk for HIV. They were less aware of PrEP compared to self-identified gay MSM, partly attributed to target-group specific community-based prevention efforts. Most participants disclosed HIV only to those closest to them, and the anticipated and perceived lack of social support influenced acceptance. Feelings of internalized HIV stigma and homophobia prevented HIV disclosure, especially among heterosexuals and heterosexual and bisexual MSM.

Conclusion: This study revealed important differences in the networks of gay-identified MSM, heterosexuals and hetero- and bisexual identified MSM influencing sexual risk taking and prevention behavior. Future prevention initiatives should be inclusive and mainstreamed to ensure to address those who do not identify as belonging established key populations. Awareness of HIV and biomedical prevention should be raised in the general population, providing a base on which tailored prevention can be built. Involving family physicians and socially empowering people living with HIV may help to decrease anticipated and internalized HIV stigma.