LEVERAGING SOCIAL NETWORKS TO FIGHT HIV: THE BATTLE OF FEMALE SEX WORKERS

Abstract

This dissertation aims to assess the applicability of the social network method on HIV research among female sex workers (FSWs). Manuscript 1 reported the findings from a systematic literature review which examined the application of social network method in HIV studies focusing on FSWs. The majority of the identified studies were limited to local social networks or FSW establishments and did not use sophisticated statistical approaches to analyze sociocentric network data. The discrepancies in network definitions and data collections made it difficult in interpreting their findings and assessing validity. Most of the analytic plans for egocentric studies were limited to information at the individual level rather than that at the ego-alter ties. The project reported in manuscripts 2 and 3 used empirical data from a multi-center egocentric network study among mid-age FSWs in China to assess the extent to which social network components influence HIV testing behaviors (paper 2), and the associations between Chinese collectivist culture and FSWs’ social networks (paper 3). As reported in the manuscript 2, among 1,245 FSWs, 62.2% of them received an HIV test. HIV testing was positively associated with higher network transitivity (AOR: 1.77; 95% CI: 1.18-2.64) and inversely associated with network trust (AOR: 0.74; 95% CI: 0.56-0.97). Although social support was not associated with HIV testing, the increase in social cohesion may provide substantial support for HIV testing. As documented in manuscript 3, Chinese collectivism tendency was negatively associated with their perceived social support (95% CI: -0.33, -0.04), network effective size (95% CI: -0.30, -0.01), and network betweenness (95% CI: -0.33, -0.09). FSWs who had the highest level of collectivistic tendency and perceived a higher level of stigma are more likely to stay at a “bridging” position and connect with weak social ties rather than a strong cohesive group. This dissertation projects provide empirical evidence that social networks can be used to analyze the social environment of FSWs and its impact on HIV preventive behaviors among this HIV vulnerable population. The findings make additional contributions to the application of social network methods in social and behavioral research with a focus on FSWs.