A Multilevel Analysis of Social Network Characteristics and Technology Use on HIV Risk and Protective Behaviors Among Transgender Women

  • Cathy J. Reback
  • Kirsty Clark
  • Jesse B. Fletcher
  • Ian W. Holloway
Original Paper


This study examined the empirical structure (i.e., size, density, duration) of transgender women’s social networks and estimated how network alters’ perceived HIV risk/protective behaviors influenced transgender women’s own HIV risk/protective behaviors. From July 2015 to September 2016, 271 transgender women completed surveys on sociodemographic characteristics, HIV risk/protective behaviors, and social networks. Hierarchical generalized linear models examined the associations of social network alter member data ‘nested’ within participant data. Analyses revealed that social network factors were associated with HIV risk/protective behaviors, and that the gender identity of the alters (cisgender vs. transgender), and social network sites and technology use patterns (“SNS/tech”) moderated these associations. Among network alters with whom the participant communicated via SNS/tech, participants’ HIV risk behavior was positively associated with alters’ HIV risk behavior (cisgender alters aOR 4.10; transgender alters aOR 5.87). Among cisgender alters (but not transgender alters) with whom the participant communicated via SNS/tech, participants’ HIV protective behavior was positively associated with alters’ HIV protective behavior (aOR 8.94).


Transgender Social networks Technology HIV 



This study was supported by the National Institute on Drug Abuse, Grant #R21DA037816. Drs. Reback and Holloway acknowledge additional support from the National Institute of Mental Health (P30 MH58107). Ms. Clark acknowledges funding support from the Graduate Division, UCLA Fielding School of Public Health (Fellowship in Epidemiology, #104733842). Dr. Holloway acknowledges funding support from the California HIV/AIDS Research Program (RP15-LA-007). The authors would like to acknowledge, thank, and express deep gratitude to the research assistants, without their dedication to both the participants and the aims of the study, this study would have been lacking.

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

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 2019

Authors and Affiliations

  1. 1.Friends Research Institute, Inc.Los AngelesUSA
  2. 2.David Geffen School of MedicineSemel Institute of Neuroscience and Human Behavior, University of CaliforniaLos AngelesUSA
  3. 3.Center for HIV Identification, Prevention and Treatment ServicesUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Epidemiology, Fielding School of Public HealthUniversity of CaliforniaLos AngelesUSA
  5. 5.Department of Social Welfare, Luskin School of Public AffairsUniversity of CaliforniaLos AngelesUSA

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