1. Developing Measures of Pathways That May Link Large-scale Social Structural Factors with HIV Epidemiology
Enrique R. Pouget, Milagros Sandoval, Yolanda Jones, Georgios K. Nikolopoulos, Pedro Mateu-Gelabert, & Samuel R. Friedman
Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
BACKGROUND
CULTURAL-HISTORY ACTIVITY THEORY (CHAT)3
PARTICIPANT CHARACTERISTICS
Structural interventions, such as legalization and regulation of sex work or of drug use, can alter risk contexts and reduce HIV exposures and transmission.
“Big events,” such as wars, civil insurrection and natural disasters sometimes act as negative structural interventions to increase the number of people who engage in sexual and injection risk behavior, and to reshape social networks so that more infected people have sex or share injection syringes with uninfected people.1,2
HIV/AIDS researchers have called for new measurements to enable studies of how large-scale social structural factors may affect HIV epidemics.
Few measures exist at the individual level that could be used to assess structural influences or potential effects of future structural interventions or big events.
CHAT suggests that understanding culture and history is essential for understanding behaviors. We used 3 core CHAT concepts to guide development of new measures.
INDIVIDUAL, PARTNERED, AND GROUP ACTIVITIES. Formal and informal group memberships; time-use; helping others.
INTER-SUBJECTIVE EXCHANGES; NORMS AND ROLES IN PROXIMAL SOCIAL CONTEXTS. Norms on participating in groups, sexual behavior, drug use, and risk behaviors in sex and drug-related venues.
SELF AS A SUBJECTIVE PROCESS; EXPERIENCES OF NORMATIVE CONFLICTS—PERCEPTIONS AND REACTIONS. Experiences of dignity denial and reactions; generational normative disjuncture; injection norms in the context of withdrawal; group and class solidarity; competitive, hostile and altruistic orientations.
Age: mean = 40.9 years (Min = 19, Max = 62)
Male gender = 55%
African American/black race = 55%
Hispanic/Latino ethnicity = 43%
Education < 12th grade and no GED = 38%
Never married = 44%
Homeless = 19%
Income below $10,000 = 62%
HIV-positive = 21%
Injected drugs daily = 55%
Shared syringes = 28%
Exchanged sex for money or drugs = 19%
PRELIMINARY RESULTS AMONG 300 PWID IN NYC,
CONCLUSIONS
Num Cronbach Corr.
New Scale Items Alpha w/criteria
A. Helping others
B. Norms on participating in group activities
Norms on sexual behavior
Norms on using drugs
Group sex rules
Group sex norms and roles
Sex norms, rules and roles at drug-using venues
Drug norms, rules and roles and drug-using venues
C. Dignity denial reaction
Witnessing dignity denial reaction
Injection norms in the context of withdrawal
Generational normative disjuncture (young adult)
Generational normative disjuncture (older adult)
Group and class solidarity
Social struggle and organizing
Traditional attitudes in the context of hard times
Competitiveness in the context of hard times
Hostility in the context of hard times
Altruism in the context of hard times
Note. Criterion variables included: income, condom use at group sex events (in the last 12 months), helping others during Hurricane Sandy, and risk behaviors in the past 30 days: numbers of sex partners, exchange sex, distributive syringe sharing.
Most scales and items (not shown) demonstrate evidence of validity and reliability.
Comparing results among PWID, HRH and MSM will allow us to assess generalizability, and compare convergent and divergent validity.
These measures may be used to understand future HIV epidemics.
REFERENCES
MEASURES DEVELOPMENT PROCESS
Friedman SR, Rossi D, Braine N. Theorizing ‘‘Big Events’’ as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks. Int J Drug Policy. 2009;20:283–91.
Friedman SR, Sandoval M, Mateu-Gelabert P, Rossi D, Gwadz M, Dombrowski K, Smyrnov P, Vasylyeva T, Pouget ER, Perlman D. Theory, measurement and hard times: some issues for HIV/AIDS research. AIDS Behav Jul;17(6):
Stetsenko A, Arievitch I. The self in cultural–historical activity theory: reclaiming the unity of social and individual dimensions of human development. Theory Psychol. 2004;14:475–503.
Ethnography and interviewing with people who inject drugs (PWID), men who have sex with men (MSM), and high-risk heterosexuals (HRH), , using network-based sampling in New York City.
4 Focus groups
18 in-depth interviews
17 pilot interviews
300 PWID—results below
300 HRH—data being prepared for analysis
300 MSM—data being collected
ACKNOWLEDGEMENTS
NIDA R01DA “Developing Measures to Study How Structural Interventions May Affect HIV Risk”
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