Use of Social Network Strategy Among Young Black Men Who Have Sex With Men for HIV Testing, Linkage to Care, and Reengagement in Care, Tennessee, 2013-2016

Abstract

Objectives: Tennessee was 1 of 8 states that received funding from the Care and Prevention in the United States Demonstration Project, which aimed to reduce HIV-related morbidity and mortality among racial/ethnic and sexual minority populations. The objective of this study was to describe implementation of a social network strategy (SNS) program, which leverages personal connections in social networks, to reach people with undiagnosed HIV infection for HIV testing. We targeted young black men who have sex with men (MSM) at 3 agencies in Memphis and Nashville, Tennessee, during 2013-2016.

Methods: Specialists at the 3 agencies identified MSM with and without diagnosed HIV infection (ie, recruiters) who could recruit members from their social networks for HIV testing (ie, network associates). Both recruiters and network associates received OraQuick rapid and confirmatory HIV tests. We used χ² and Fisher exact tests to assess differences in demographic characteristics, HIV testing, and care engagement status by agency.

Results: Of 1752 people who were tested for HIV in the SNS program, 158 (9.0%) tested positive; of these, 80 (50.6%) were newly diagnosed with HIV. Forty-seven of the 78 (60.3%) people who were previously diagnosed with HIV were not in care in the previous 12 months; of these, 27 (57.4%) were reengaged in medical care. Of 80 people newly diagnosed with HIV, 44 (55.0%) were linked to care.

Conclusions: The SNS program ascertained HIV status among a high-risk population in a heavily burdened region. Further program evaluation is needed to understand how to improve linkage to care among people with newly diagnosed HIV.

Keywords: HIV; South; black men who have sex with men; social network.

Figure 1.

Hierarchical structure of the social network strategy (SNS) program to reach people with undiagnosed HIV infection for HIV testing, among primarily young black men who have sex with men in Memphis and Nashville, Tennessee, June 1, 2013–June 30, 2016. The SNS approach assumes that people who engage in high-risk behaviors cluster in networks with people who engage in similar behaviors. Social network strategy program specialists identified MSM with and without diagnosed HIV (“recruiters”) to bring in members of their social network (“network associates”) for HIV testing services. All network associates and recruiters were tested for HIV. The network index (the number of network associates divided by the number of recruiters) was a measure of the efficiency of the SNS program. The program was part of the Care and Prevention in the United States Demonstration Project, a 4-year (2012-2016) cross-agency demonstration project led by the Centers for Disease Control and Prevention to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in the United States.

Figure 2.

Kernel density distribution of HIV tests, by agency, as part of a social network strategy program that leveraged social networks to reach primarily young black men who have sex with men with undiagnosed HIV infection for HIV testing, Memphis and Nashville, Tennessee, June 1, 2013–June 30, 2016. The smoothed curves depict the instantaneous probability and frequency of HIV testing over time. The program was part of the Care and Prevention in the United States Demonstration Project, a 4-year (2012-2016) cross-agency demonstration project led by the Centers for Disease Control and Prevention to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in the United States.