AIDS and Behavior

, Volume 23, Issue 6, pp 1604–1611 | Cite as

Role of Social Network Sexual Norms and Behaviors on the HIV Sexual Risk Behaviors of People Who Inject Drugs in HPTN 037

  • Diana M. SheehanEmail author
  • Russell P. Miller
  • Mary Jo Trepka
  • Laramie R. Smith
  • Carl Latkin
Original Paper


This study examined the effect of social network descriptive sexual norms and behaviors on the sexual behaviors of people who inject drugs (PWID). Data from HPTN037 of 232 PWID (egos) and 464 network members (alters) were used in multilevel multivariate logistic regression models. Egos whose alters reported multiple sex partners had greater odds of multiple sex partners (aOR 2.20, 1.13–4.29). Egos’ norms of condomless sex with primary (aOR 2.67, 1.15–6.17) and casual (aOR 2.38, 1.01–5.59) partners and egos’ norms of giving (aOR 5.52, 1.87–16.25) and receiving (aOR 7.38, 1.34–40.66) money/drugs for sex were associated with the egos’ respective behaviors. History of sex between an ego and alter was not associated with increased influence of alters’ norms and behaviors on egos’ sexual behavior. Findings provide support for developing interventions that target descriptive norms and selective network behavioral characteristics to decrease sexual HIV risk behavior among PWID.


People who inject drugs Sexual risk behavior HIV Social norms Social networks 



Research reported in this publication was supported by the HIV Prevention Trials Network (HPTN) Scholars Program through the National Institute of Allergy and Infectious Disease of the National Institutes of Health (UM1AI068619) and through grants from the National Institute on Drug Abuse (NIDA; K01DA039767 and R01DA040488). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research conducted in this publication was also partially supported by a Florida International University McNair Graduate Fellowship (Miller RP).

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.


  1. 1.
    Centers for Disease Control and Prevention. HIV and injection drug use. Accessed February 23, 2018.
  2. 2.
    Copenhaver MM, Johnson BT, Lee IC, Harman JJ, Carey MP. Behavioral HIV risk reduction among people who inject drugs: meta-analytic evidence of efficacy. J Subst Abuse Treat. 2006;31(2):163–71.Google Scholar
  3. 3.
    Walter AW, Cheng DM, Lloyd-Travaglini CA, Samet JH, Bernstein J, Saitz R. Are decreases in drug use risk associated with reductions in HIV sex risk behaviors among adults in an urban hospital primary care setting? Prev Med Rep. 2016;4:410–6.Google Scholar
  4. 4.
    Valente TW. Social networks and health: models, methods, and applications. New York: Oxford University Press Inc; 2010.Google Scholar
  5. 5.
    Smith KP, Christakis NA. Social networks and health. Annu Rev Sociol. 2008;34:405–29.Google Scholar
  6. 6.
    Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.Google Scholar
  7. 7.
    Koram N, Liu H, Li J, Li J, Luo J, Nield J. Role of social network dimensions in the transition to injection drug use: actions speak louder than words. AIDS Behav. 2011;15(7):1579–88.Google Scholar
  8. 8.
    Lakon CM, Ennett ST, Norton EC. Mechanisms through which drug, sex partner, and friendship network characteristics relate to risky needle use among high risk youth and young adults. Soc Sci Med. 2006;63(9):2489–99.Google Scholar
  9. 9.
    Tsang MA, Schneider JA, Sypsa V, et al. Network characteristics of people who inject drugs within a new HIV epidemic following Austerity in Athens, Greece. J Acquir Immune Defic Syndr. 2015;69(4):499–508.Google Scholar
  10. 10.
    Latkin CA, Kuramoto SJ, Davey-Rothwell MA, Tobin KE. Social norms, social networks, and HIV risk behavior among injection drug users. AIDS Behav. 2010;14(5):1159–68.Google Scholar
  11. 11.
    De P, Cox J, Boivin JF, Platt RW, Jolly AM. The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction. 2007;102(11):1730–9.Google Scholar
  12. 12.
    Mulawa M, Yamanis TJ, Hill LM, Balvanz P, Kajula LJ, Maman S. Evidence of social network influence on multiple HIV risk behaviors and normative beliefs among young Tanzanian men. Soc Sci Med. 2016;153:35–43.Google Scholar
  13. 13.
    Smith LR, Strathdee SA, Metzger D, Latkin C. Evaluating network-level predictors of behavior change among injection networks enrolled in the HPTN 037 randomized controlled trial. Drug Alcohol Depend. 2017;175:164–70.Google Scholar
  14. 14.
    Perkins HW, Berkowitz AD. Perceiving the community norms of alcohol use among students: some research implications for campus alcohol education programming. Int J Addict. 1986;21(9–10):961–76.Google Scholar
  15. 15.
    Latkin C, Donnell D, Liu TY, Davey-Rothwell M, Celentano D, Metzger D. The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users. Addiction. 2013;108(5):934–43.Google Scholar
  16. 16.
    Ridout B, Campbell A. Using Facebook to deliver a social norm intervention to reduce problem drinking at university. Drug Alcohol Rev. 2014;33(6):667–73.Google Scholar
  17. 17.
    Tobin K, Davey-Rothwell M, Latkin C. Social-level correlates of shooting gallery attendance: a focus on networks and norms. AIDS Behav. 2010;14(5):1142–8.Google Scholar
  18. 18.
    Davey-Rothwell MA, Latkin CA. HIV-related communication and perceived norms: an analysis of the connection among injection drug users. AIDS Educ Prev. 2007;19(4):298–309.Google Scholar
  19. 19.
    Davey-Rothwell MA, Latkin CA. Gender differences in social network influence among injection drug users: perceived norms and needle sharing. J Urban Health. 2007;84(5):691–703.Google Scholar
  20. 20.
    National Drug Early Warning System. Philadelphia Sentinel Community Site (SCS) Drug Use Patterns and Trends, 2017. Accessed November 21, 2018.
  21. 21.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. Published November 2018. Accessed November 21, 2018.
  22. 22.
    Latkin CA, Donnell D, Metzger D, et al. The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai, Thailand and Philadelphia, USA. Soc Sci Med. 2009;68(4):740–8.Google Scholar
  23. 23.
    Van de Bongardt D, Reitz E, Sandfort T, Deković M. A meta-analysis of the relations between three types of peer norms and adolescent sexual behavior. Pers Soc Psychol Rev. 2015;19(3):203–34.Google Scholar
  24. 24.
    Jones J, Salazar LF, Crosby R. Contextual factors and sexual risk behaviors among young, black men. Am J Mens Health. 2017;11(3):508–17.Google Scholar
  25. 25.
    Kapadia F, Frye V, Bonner S, Emmanuel PJ, Samples CL, Latka MH. Perceived peer safer sex norms and sexual risk behaviors among substance-using Latino adolescents. AIDS Educ Prev. 2012;24(1):27–40.Google Scholar
  26. 26.
    Longshore D, Stein JA, Chin D. Pathways to sexual risk reduction: gender differences and strategies for intervention. AIDS Behav. 2006;10(1):93–104.Google Scholar
  27. 27.
    Huebner DM, Neilands TB, Rebchook GM, Kegeles SM. Sorting through chickens and eggs: a longitudinal examination of the associations between attitudes, norms, and sexual risk behavior. Health Psychol. 2011;30(1):110–8.Google Scholar
  28. 28.
    Barman-Adhikari A, Begun S, Rice E, Yoshioka-Maxwell A, Perez-Portillo A. Sociometric network structure and its association with methamphetamine use norms among homeless youth. Soc Sci Res. 2016;58:292–308.Google Scholar
  29. 29.
    Kelly JA, Amirkhanian YA, Seal DW, et al. Levels and predictors of sexual HIV risk in social networks of men who have sex with men in the midwest. AIDS Educ Prev. 2010;22(6):483–95.Google Scholar
  30. 30.
    Schneider JA, Cornwell B, Ostrow D, et al. Network mixing and network influences most linked to HIV infection and risk behavior in the HIV epidemic among black men who have sex with men. Am J Public Health. 2013;103(1):e28–36.Google Scholar
  31. 31.
    Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sex Transm Dis. 2006;33(7 Suppl):S39–45.Google Scholar
  32. 32.
    Neblett RC, Davey-Rothwell M, Chander G, Latkin CA. Social network characteristics and HIV sexual risk behavior among urban african american women. J Urban Health. 2011;88(1):54–65.Google Scholar
  33. 33.
    Friedman SR, Bolyard M, Mateu-Gelabert P, et al. Some data-driven reflections on priorities in AIDS network research. AIDS Behav. 2007;11(5):641–51.Google Scholar
  34. 34.
    Rudolph AE, Linton S, Dyer TP, Latkin C. Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005–2007). AIDS Behav. 2013;17(2):598–611.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Diana M. Sheehan
    • 1
    • 2
    Email author
  • Russell P. Miller
    • 1
  • Mary Jo Trepka
    • 1
  • Laramie R. Smith
    • 3
  • Carl Latkin
    • 4
  1. 1.Department of Epidemiology, Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiUSA
  2. 2.Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD)Florida International UniversityMiamiUSA
  3. 3.Division of Global Public HealthUniversity of California San Diego, UCSD School of MedicineLa JollaUSA
  4. 4.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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