Developing a Sexual Network Intervention for HIV Prevention

Jennifer Hecht and Colette Auerswald, STOP AIDS Project

Twenty-five years into the HIV epidemic in California, men who have sex with men (MSM) continue to get infected at unacceptably high rates. New and innovative prevention approaches are needed if the epidemic is to be curtailed. Network-level data, measuring the social and sexual connections between individuals, suggest that partner selection and environmental factors may drive HIV transmission as much if not more than individual level risk. Given that the epidemic must propagate from infected to uninfected persons through networks, it is critical to learn where and how persons select their sexual partners.

Studies of ways in which physical places affects risk, have suggested that venues may act as markers for network- level risk by acting as physical spaces where transmission occurs, or as spaces where disassortative mixing takes place.

Disassortative mixing refers to sexual partnerships between any two groups (i.e. age, ethnicity, social group, risk level, sero-status). The disassortative mixing that this proposal addresses is that which occurs between high- and low-risk MSM. Our proposal aims to strategically intervene on the local epidemic by targeting our prevention efforts on "mixing venues" to reduce transmission.

STOP AIDS, a leader in community-based HIV prevention, has two decades of experience conducting outreach, individual counseling, workshops, and collaborating with gatekeepers to social and sexual venues in the gay community of San Francisco. STOP AIDS has recently begun collecting network-based data from MSM during outreach sessions. These data represent the largest sample of community-recruited, network-level data on MSM in San Francisco to date.

STOP AIDS (J. Hecht, MPH, PI#1) developed a collaboration to create a model program that brings together expertise in epidemiology and HIV sero-surveillance (W. McFarland, MD, PhD), venue assessment (C. Auerswald, MD, MS, PI#2) and structural interventions for MSM (D. Wohlfeiler, MJ, MPH, Key Collaborator). Our collaboration aims to reduce HIV transmission among gay and bisexual men by modifying sexual network architecture through venue-based structural interventions.

  • Aim #1: Dr. McFarland and STOP AIDS will analyze venue-based data from 1500 individuals to identify venues where disassortative mixing takes place.
  • Aim #2: We will describe the identified venues. Using qualitative and quantitative methods, Dr. Auerswald and STOP AIDS will characterize the transmission-related characteristics of targeted venues, elicit the rules for sexual partnering operative in selected venues, and describe characteristics of venues ripe for structural interventions, as well as the acceptability of these interventions.
  • Aim #3: We will design and pilot a network-level intervention to reduce disassortative mixing at selected venues.

Mr. Wohlfeiler and STOP AIDS will work with STOP AIDS' community advisory boards to develop structural interventions, which will reduce HIV transmission by modifying sexual network architecture, while maintaining basic human rights and freedom of choice.

By piloting an original approach to reducing the environmental influence on HIV risk in MSM, we have the opportunity to influence the epidemic on a new front. Our findings will be summarized and disseminated for use in other MSM communities as well for use in other communities at risk.