AIDS and Behavior

, Volume 22, Issue 9, pp 3033–3043 | Cite as

Structural Network Position and Performance of Health Leaders Within an HIV Prevention Trial

  • Marta I. MulawaEmail author
  • Thespina J. Yamanis
  • Lusajo J. Kajula
  • Peter Balvanz
  • Suzanne Maman
Original Paper


The effectiveness of peer leaders in promoting health may depend on the position they occupy within their social networks. Using sociocentric (whole network) and behavioral data from the intervention arm of a cluster-randomized HIV prevention trial in Dar es Salaam, Tanzania, we used generalized linear models with standardized predictors to examine the association between heath leaders’ baseline structural network position (i.e., in-degree and betweenness centrality) and their 12-month self-reported (1) confidence in educating network members about HIV and gender-based violence (GBV) and (2) number of past-week conversations about HIV and GBV. As in-degree centrality increased, leaders reported fewer HIV-related conversations. As betweenness centrality increased, leaders reported greater number of conversations about GBV. Network position was not significantly associated with confidence in discussing either topic. Our results suggest that peer leaders who occupy spaces between sub-groups of network members may be more effective in engaging their peers in sensitive or controversial topics like GBV than more popular peer leaders.


Network position Popular opinion leader HIV prevention Tanzania 



We wish to acknowledge the work and dedication of our study interviewers as well as our research team in Chapel Hill, NC and Dar es Salaam, Tanzania who coordinated the data collection and intervention activities for our trial including Mrema Noel Kilonzo, Dr. Kasubi Mabula, Gema Lambert, Deus Kajuna, Brenda Mkony, Joyce Kondela. We also thank the participants of our study for their contributions.


Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH098690. Additionally, M. Mulawa is supported by the National Institute of Allergy and Infectious Disease under Award Number T32AI007392. M. Mulawa also received support from the National Institute of Child Health and Human Development under Award Number R25HD079352. T. Yamanis received support from the National Institute on Drug Abuse under Award Number R25DA031608. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marta I. Mulawa
    • 1
    Email author
  • Thespina J. Yamanis
    • 2
  • Lusajo J. Kajula
    • 3
  • Peter Balvanz
    • 4
  • Suzanne Maman
    • 4
  1. 1.Duke Global Health InstituteDuke UniversityDurhamUSA
  2. 2.School of International ServiceAmerican UniversityWashingtonUSA
  3. 3.Department of Psychiatry and Mental HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
  4. 4.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA

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