Understanding Sexual and Social Networks Session 3

Learning Objectives: Understanding Sexual networks and social networks Their relevance to the spread of HIV/STI Important of identifying networks and counselling for risk reduction

Networks The sexual network included each person with whom the client had engaged in sexual activity during the window period. The social network included names of persons the participant considered ‘important’ and with whom the client had talked or spent. The drug-use networks included the persons with whom the participant had used drugs or shared needles during the window period.

How do networks affect transmission? Exclusively monogamous - not part of a sexual network. If both are HIV-negative they remain so. Serial monogamists - people who go from relationship to relationship one at a time. If they have unprotected sex, they have a higher risk of HIV/STI than exclusively monogamous people. Earlier partners’ risk may affect later partners.

How do networks affect transmission? Concurrent relationships involve having more than one sexual partner in a given period and going back and forth between them. This increases the probability for transmission, because earlier partners can be infected by later partners. Concurrent partners can connect each of their respective clusters and networks as well. Concurrency alone can fuel an epidemic even if the average number of partners is relatively low.

What are key concepts of networks? Number of unprotected partners Random spread broadens transmission Core groups Centrality

The counsellor should discuss Increasing condom use with main and/or non-main partners. Intent to reduce number of sexual partners. Enhancing partner communication and sexual negotiation. Monogamy Abstinence Sexual activities that don’t involve exchange of blood, semen or vaginal secretions Discussion with partner(s) to negotiate risk-reducing activities. Partner notification and testing Reducing use of alcohol and/or drugs. Consideration of any of the above factors. Other client-relevant behaviors.

Summary This session understanding sexual and social networks is crucial to reducing transmission rates of HIV, as an individual’s risk is greatly influenced by their location within a sexual network. Vulnerability to HIV infection does not only depend upon one's own risks but also the risks attributable to other partners in one's sexual networks.

Summary To ensure prevention and reduction of risk the counsellor should ensure clients understand perception of personal risk for STI/HIV, develop confidence in ability to negotiate condom use and should have power to bring about change. The counsellor should understand control dynamics of relationships, be sensitive to cultural issues, create access to health and encourage and support reduction of risk behaviour.