AIDS and Behavior

, Volume 14, Issue 5, pp 1159–1168 | Cite as

Social Norms, Social Networks, and HIV Risk Behavior Among Injection Drug Users

  • C. A. Latkin
  • S. J. Kuramoto
  • M. A. Davey-Rothwell
  • K. E. Tobin
Original Paper


Social network structure and norms are linked to HIV risk behavior. However little is known about the gradient of norm of HIV risk that exists among social networks. We examined the association between injection risk network structure and HIV risk norms among 818 injection drug users (IDUs). IDUs were categorized into four distinct groups based on their risk behaviors with their drug networks: no network members with whom they shared cookers or needles, only cooker-sharing member, one needle-sharing member, and multiple needle-sharing members. The riskiest group, networks of multiple needle sharers, was more likely to endorse both risky needle-sharing and sex norms. Networks of only cooker sharers were less likely to endorse high-risk norms, as compared to the networks with no sharing. There were also differences based on gender. Future HIV prevention interventions for IDUs should target both injection and sex risk norms, particularly among IDUs in the multiple needle-sharing networks.


Social norms Social network Needle sharing HIV risk Injection drug use Gender 



This work was funded by the National Institute on Drug Abuse (grant# 1RO1 DA016555 and 1F31 DA026318).


  1. Bailey, S. L., Ouellet, L. J., Mackesy-Amiti, M. E., Golub, E. T., Hagan, H., Hudson, S. M., et al. (2007). Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities. Drug and Alcohol Dependence, 91(S1), S18–S29.CrossRefPubMedGoogle Scholar
  2. Barnard, M. A. (1993). Needle sharing in context: Patterns of sharing among men and women injectors and HIV risks. Addiction (Abingdon, England), 88, 805–812. doi:10.1111/j.1360-0443.1993.tb02094.x.Google Scholar
  3. Barrera, M., & Gottlieb, B. H. (1981). Social support in the adjustment of pregnant adolescents: Assessment issues. In B. H. Gottlieb (Ed.) Social networks and social support (pp. 61–96). Baverly Hills, CA: Sage.Google Scholar
  4. Bettenhausen, K., & Murnighan, J. K. (1985). The emergence of norms in competitive decision-making groups. Administrative Science Quarterly, 30(3), 350–372. doi:10.2307/2392667.CrossRefGoogle Scholar
  5. Cialdini, R. B., Reno, R. R., & Kallgreen, C. A. (1990). A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58, 1015–1026. doi:10.1037/0022-3514.58.6.1015.CrossRefGoogle Scholar
  6. Costenbader, E. C., Astone, N. M., & Latkin, C. A. (2006). The dynamics of injection drug users’ personal networks and HIV risk behaviors. Addiction (Abingdon, England), 101(7), 1003–1013. doi:10.1111/j.1360-0443.2006.01431.x.Google Scholar
  7. Davey-Rothwell, M. A., & Latkin, C. A. (2007). Gender differences in social network influence among injection drug users: Perceived norms and needle sharing. Journal of Urban Health, 84, 691–703. doi:10.1007/s11524-007-9215-1.CrossRefPubMedGoogle Scholar
  8. Davey-Rothwell, M. A., & Latkin, C. A. (2008). An examination of perceived norms and exchanging sex for money or drugs among women injectors in Baltimore, MD, USA. International Journal of STD & AIDS, 19(1), 47–50. doi:10.1258/Ijsa.2007.007123.CrossRefGoogle Scholar
  9. Davey-Rothwell, M. A., Latkin, C. A., & Tobin, K. E. (2009). Longitudinal analysis of the relationship between perceived norms and sharing injection paraphernalia. AIDS and Behavior (Epub ahead of print).Google Scholar
  10. De, P., Cox, J., Boivin, J.-F., Platt, R. W., & Jolly, A. M. (2007). The importance of social networks in their association to drug equipment sharing among injection drug users: A review. Addiction (Abingdon, England), 102, 1730–1739. doi:10.1111/j.1360-0443.2007.01936.x.Google Scholar
  11. Evans, J. L., Hahn, J. A., Page-Shafer, K., Lum, P. J., Stein, E. S., Davidson, P. J., et al. (2003). Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). Journal of Urban Health, 80(1), 137–146. doi:10.1093/jurban/jtg137.CrossRefPubMedGoogle Scholar
  12. Friedman, S., & Aral, S. (2001). Social networks, risk-potential networks, health, and disease. Journal of Urban Health, 78, 411–418. doi:10.1093/jurban/78.3.411.PubMedGoogle Scholar
  13. Hawkins, W. E., Latkin, C., Mandel, W., & Oziemkowska, M. (1999). Do actions speak louder than words? Perceived peer influences on needle-sharing and cleaning in a sample of injection drug users. AIDS Education and Prevention, 11(2), 122–131.PubMedGoogle Scholar
  14. Hoffmann, J. P., Su, S. S., & Pach, A. (1997). Changes in network characteristics and HIV risk behavior among injection drug users. Drug and Alcohol Dependence, 46(1–2), 41–51. doi:10.1016/S0376-8716(97)00038-0.CrossRefPubMedGoogle Scholar
  15. Latkin, C. A., Forman, V. L., Knowlton, A., & Sherman, S. (2003a). Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Social Science & Medicine, 56(3), 465–476. doi:10.1016/S0277-9536(02)00047-3.CrossRefGoogle Scholar
  16. Latkin, C. A., Hua, W., & Forman, V. L. (2003b). The relationship between social network characteristics and exchanging sex for drugs or money among drug users in Baltimore, MD, USA. International Journal of STD & AIDS, 14(11), 770–775. doi:10.1258/09564620360719831.CrossRefGoogle Scholar
  17. Latkin, C. A., Mandell, W., Oziemkowska, M., Celentano, D., Vlahov, D., Ensminger, M., et al. (1995). Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS. Drug and Alcohol Dependence, 38(1), 1–9. doi:10.1016/0376-8716(94)01082-V.CrossRefPubMedGoogle Scholar
  18. Latkin, C., Mandell, W., Vlahov, D., Oziemkowska, M., & Celentano, D. (1996). People and places: Behavioral settings and personal network characteristics as correlates of needle sharing. Journal of Acquired Immune Deficiency Syndrome, 13(3), 273–280.Google Scholar
  19. Metsch, L. R., Pereyra, M., Purcell, D. W., Latkin, C. A., Malow, R., & Gomez, C. A. (2007). Correlates of lending needles/syringes among HIV-seropositive injection drug users. Journal of Acquired Immune Deficiency Syndrome, 46(2), S72–S79. doi:10.1097/QAI.0b013e3181576818.CrossRefGoogle Scholar
  20. Miller, M., & Neaigus, A. (2001). Networks, resources and risk among women who use drugs. Social Science & Medicine, 52(6), 967–978. doi:10.1016/S0277-9536(00)00199-4.CrossRefGoogle Scholar
  21. Mizuno, Y., Kennedy, M., Seals, B., & Myllyluoma, J. (2000). Predictors of teens’ attitudes toward condoms: Gender differences in the effects of norms. Journal of Applied Social Psychology, 30, 1381–1395. doi:10.1111/j.1559-1816.2000.tb02526.x.CrossRefGoogle Scholar
  22. Neaigus, A. (1998). The network approach and interventions to prevent HIV among injection drug users. Public Health Reports, 113(supp1), 140–150.PubMedGoogle Scholar
  23. Neaigus, A., Friedman, S. R., Kottiri, B. J., & Des Jarlais, D. C. (2001). HIV risk networks and HIV transmission among injecting drug users. Evaluation and Program Planning, 24(2), 221–226. doi:10.1016/S0149-7189(01)00012-X.CrossRefGoogle Scholar
  24. Newcomb, T. M. (1950). Social psychology. The Dryden Press, Inc: New York.CrossRefGoogle Scholar
  25. Page, J. B., Smith, P. C., & Kane, N. (1990). Shooting galleries, their proprietors, and implications for prevention of AIDS. Drugs and Society, 5, 69–85. doi:10.1300/J023v05n01_06.CrossRefGoogle Scholar
  26. Reifman, A., Watson, W. K., & McCourt, A. (2006). Social networks and college drinking: Probing processes of social influence and selection. Personality and Social Psychology Bulletin, 32(6), 820–832. doi:10.1177/0146167206286219.CrossRefPubMedGoogle Scholar
  27. Rhodes, T., Singer, M., Bourgois, P., Friedman, S. R., & Strathdee, S. A. (2005). The social structural production of HIV risk among injecting drug users. Social Science & Medicine, 61(5), 1026–1044. doi:10.1016/j.socscimed.2004.12.024.CrossRefGoogle Scholar
  28. Shaw, S. Y., Shah, L., Jolly, A. M., & Wylie, J. L. (2007). Determinants of injection drug user (IDU) syringe sharing: The relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada. Addiction (Abingdon, England), 102(10), 1626–1635. doi:10.1111/j.1360-0443.2007.01940.x.Google Scholar
  29. Sherman, S. G., Latkin, C. A., & Gielen, A. C. (2001). Social factors related to syringe sharing among injecting partners: A focus on gender. Substance Use & Misuse, 36(14), 2113–2136. doi:10.1081/JA-100108439.CrossRefGoogle Scholar
  30. Unger, J. B., Kipke, M. D., De Rosa, C. J., Hyde, J., Ritt-Olson, A., & Montgomery, S. (2006). Needle-sharing among young IV drug users and their social network members: The influence of the injection partner’s characteristics on HIV risk behavior. Addictive Behaviors, 31(9), 1607–1618. doi:10.1016/j.addbeh.2005.12.007.CrossRefPubMedGoogle Scholar
  31. Valente, T. W., & Vlahov, D. (2001). Selective risk taking among needle exchange participants: Implications for supplemental interventions. American Journal of Public Health, 91(3), 406–411. doi:10.2105/AJPH.91.3.406.CrossRefPubMedGoogle Scholar
  32. van Empelen, P., Schaalma, H. P., Kok, G., & Jansen, M. W. J. (2001). Predicting condom use with casual and steady sex partners among drug users. Health Education Research, 16(3), 293–305. doi:10.1093/her/16.3.293.CrossRefPubMedGoogle Scholar
  33. Wasserman, S., & Faust, K. (1994). Social network analysis: Methods and applications. Cambridge University Press: Cambridge.Google Scholar
  34. Zeger, S. L., & Liang, K.-Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42(1), 121–130. doi:10.2307/2531248.CrossRefPubMedGoogle Scholar
  35. Zucker, L. G. (1977). The role of institutionalization in cultural persistence. American Sociological Review, 42(5), 726–743. doi:10.2307/2094862.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • C. A. Latkin
    • 1
  • S. J. Kuramoto
    • 2
  • M. A. Davey-Rothwell
    • 2
  • K. E. Tobin
    • 2
  1. 1.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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