A Pilot Test of Game Changers, a Social Network Intervention to Empower People with HIV to be Prevention Advocates in Uganda

Abstract

We conducted a pilot randomized controlled trial of Game Changers, a 6-session group intervention that empowers people with HIV to be HIV prevention advocates in their social networks. Ninety-nine people with HIV (51 intervention, 48 wait-list control) and 58 of their social network members (alters) completed baseline and 5- and 8-month post-baseline assessments. Results indicated high acceptability, demonstrated by participants' and facilitators' positive attitudes qualitatively and favorable ratings of intervention sessions quantitatively, and high feasibility (76% attended all intervention sessions). Intention-to-treat analyses indicated significantly increased HIV prevention advocacy among HIV-positive participants and alters [b (SE) = 0.4 (0.2), p = .017; b (SE) = 0.4 (0.2), p = .035]; reduced internalized HIV stigma [b (SE) = - 0.3 (0.1), p = .012], increased HIV-serostatus disclosure [b (SE) = 0.1 (0.1), p = .051], and increased social network density among HIV-positive participants [b (SE) = 0.1 (0.03), p = .004]; and marginally reduced condomless sex among alters [OR (95% CI) = 0.3 (0.1-1.2), p = .08]. Positioning people with HIV as central to prevention has the potential to reduce stigma and improve prevention outcomes throughout social networks.

Keywords: HIV/AIDS; Health promotion/prevention; Peer intervention; Social network analysis; Uganda.

Figure I.

Conceptual Model of Game Changers Intervention

Figure II.

CONSORT Flow Diagram for Index Participants (People with HIV)

Figure III.

CONSORT Flow Diagram for Social Network Members (Alters) of Index Participants

Figure IV.

Social network diagrams for intervention and control participants at baseline and 8-month follow-up, illustrating changes in density over time. Both participants have about average density at baseline. The intervention participant’s density remains similar over time (.3 at baseline, .3 at follow-up), whereas the control participant’s density decreases (.3 at baseline, .2 at follow-up). The size of the nodes correspond to the number of ties for each alter, with the largest node in each diagram representing the maximum degree value.