Skip to content

EpiC Blog

PEPFAR, USAID, MOSAIC
  • Home
  • About
  • Global Impact
  • Events
  • Resources
    • Social & Behavior Change
    • Mental Health and Psychosocial Support
    • HIV Trainings, Tools and Guides
    • Decentralized Drug Distribution
    • HIV Success Stories
    • HIV Country Resources
    • COVID-19 Trainings, Tools and Guides
    • COVID-19 Success Stories
    • COVID-19 Country Resources
  • Follow Us
Search
START TYPING AND PRESS ENTER TO SEARCH
  • Home
  • About
  • Global Impact
  • Events
  • Resources
    • Social and Behavior Change
    • Mental Health and Psychosocial Support
    • HIV Trainings, Tools and Guides
    • Decentralized Drug Distribution
    • HIV Success Stories
    • HIV Country Resources
    • COVID 19 Trainings, Tools and Guides
    • COVID-19 Success Stories
    • COVID-19 Country Resources
  • COVID-19
  • Follow Us

You are who you know: Social networks, super-mobilizers, and sex (Part III)

October 16, 2017

Written by LINKAGES’ Hally Mahler, Eric Stephan, Matthew Avery, and Virupax Ranebennur

A version of this blog post was originally presented at FHI 360’s Global Leadership Meeting 2017 and USAID’s Global Health Mini-University 2017.


fixed

Photos courtesy of Thai Red Cross AIDS Research Center.

Read Part I and Part 2 of this three-part blog series here.

Motivated by the success we had in Chiang Mai, the LINKAGES team set out to find if similar social network approaches could be applied to men who have sex with men (MSM) in India – where 90 percent of MSM in Mumbai use virtual spaces to seek sexual partnerships.

Within the first three weeks of the pilot, mobilizers were able to reach 333 MSM who solicit sexual relationships through social apps, 93 of whom sought prevention, care, and treatment services including HIV testing. Almost all of these MSM individuals were university students that were not being reached through traditional, targeted intervention programs. As a result of the pilot’s success in utilizing social networks, the team observed an HIV yield increase from 1 percent to 4.1 percent, and a 9 percent syphilis yield. What did the data tell us? This group of young men were a previously unreachable priority population with a significantly high risk of HIV.

Expanding out of Asia

Currently, LINKAGES has expanded implementation efforts of the Enhanced Peer Mobilizer (EPM) model in five countries in Africa – Botswana, Burundi, Cote d’Ivoire, Democratic Republic of Congo, and Malawi. These new experiences have taught us lessons about how social networks work in different contexts.

In Botswana, LINKAGES is working exclusively with female sex workers (FSWs). In November 2016, we designed a pilot strategy based on the EPM model in an effort to reach FSWs online. Within the first four weeks, we tested 1,665 FSWs compared to the 951 FSWs reached in the previous quarter. An analysis of one district in Francistown revealed that 282 FSWs were brought in for HIV testing by only three super-mobilizers; 93 percent of those were first time users of LINKAGES’ HIV services. The HIV case finding increased from 13 percent at the start of the pilot to 31 percent. The deeper we got into the social networks, the more HIV-positive sex workers we found and linked to care.

LINKAGES discovered a similar trend in Burundi, where there was a large increase in case finding reported from all implementing partners, both in urban and rural areas. We then took the approach to MSM groups in Cote d’Ivoire and Malawi, and again in both cases we saw improvements in HIV case finding. The proof of concept is strong, but the challenge we now face is getting the approach to scale. LINKAGES achieved what is now called the Enhanced Peer Outreach Approach (EPOA) in Thailand and learned many lessons along the way that will inform our plans to scale up elsewhere.ee.jpg

What we have learned

  • The Enhanced Peer Outreach Approach has the power to reach previously unreached – and sometimes unknown – networks of MSM and FSWs.
  • From this early view, MSM and FSW networks may tend to look different. MSM networks usually have a single individual surrounded by many contacts, whereas FSW networks tend to present in waves and branches. The higher use of social media by MSM individuals may contribute to this.
  • High levels of social media use by targeted key populations is beneficial for scale but not essential for success.
  • HIV-positive mobilizers tend to bring in a higher percentage of HIV case finding.
  • The longer the strings, the more HIV case finding for FSWs and some MSM groups – especially where social media is not used. We see higher yields come in around the third and fourth waves when we are reaching people not previously reached by the project.
  • It is imperative to seek mobilizers with social networks outside of the groups we are already reaching through other methods. We had a few cases in which the coupons never left the community who were already being reached by traditional program interventions, thus resulting in no additional case finding.

Considerations for the future of the Enhanced Peer Outreach Approach

  • Incentives have been important to the success of the program – be they direct payment or in-kind incentives. It is important for any incentives to be tailored to the country context in consultation with the KP groups that will be reached by the program.
  • The use of mobilizers does not replace more traditional peer outreach workers! We still need outreach workers to maintain contact with new clients once they have been found. We are pursuing questions about how to keep mobilizers motivated, and how to further expand program promotion once personal social networks have been exhausted.
  • Since the Enhanced Peer Outreach Approach brings in people who have never had contact with the program previously, it may be harder to effectively link them to care and treatment and continue to support them in the community.

bb

You are who you know

There is still so much to be done, and we suspect that – when it comes to social networks, super-mobilizers, and sex – we have just reached the tip of the iceberg in our learning. What we do know is this: online social networks have dealt a substantial blow to the way a number of industries have worked for decades, including the news, television, job-hunting, shopping, and entertainment. These industries have been disrupted and recreated with online tools and spaces, and the same holds true for LINKAGES’ work. In Thailand and India, we saw people in online social spaces take on the task of referring their peers to HIV services themselves, in much the same way that young people now become salespeople or social media stars (i.e. “Instagram-famous”) due to their own personal branding.

As we saw in Botswana, even without a strong social media presence, key population communities around the world can harness their social power, through their own networks to become gatekeepers for HIV education, outreach, referrals, and even care and treatment. In an ever-changing online and off-line landscape, we believe this is a positive development. It will require us to continuously evolve, but innovation is both inevitable and necessary for progress. And, in the end, you truly are who you know, and who you know can make all the difference in bringing an end to HIV.

Share this:

  • Post

Post navigation

Previous

Social networks, vulnerability, and sex: Improving HIV case finding among key populations

Next

Walking the talk: How structural barriers thwart efforts for those at risk for HIV and what we can do about it

Get Subscribed

Enter your email address to subscribe to this blog and receive notifications of new posts.

We don’t spam! Read our privacy policy for more info.

Check your inbox or spam folder to confirm your subscription.

Archives

Search by Category

Recent Publications

  • EpiC HIV Factsheet
  • EpiC COVID-19 Factsheet
  • EpiC Global Health Security Factsheet

Follow Us

  • Twitter
  • Facebook
  • Link

This blog is managed by the EpiC project and dedicated to sharing stories, events, and resources from HIV epidemic control efforts around the world.

© EpiC BLOG 2022

Assessment

A questionnaire or “screener” meant to be used with individual patients in a clinical setting to screen for, help diagnose, or monitor progress for individual mental health conditions.

Intervention

Larger packages or broader-reaching resources that describe actions or activities to be implemented. These may be appropriate for individuals, groups, and/or programs.

Anxiety

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. Anxiety can be a symptom or a feeling; it can also be a clinical diagnosis of a mental health condition.

Burnout

A state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress, typically related to one’s work, that is not managed well. Burnout is considered an occupational phenomenon.

Clinical diagnoses

Mental or neuropsychiatric disorders, or disruptive, unusual, or maladaptive behaviors that have been evaluated and diagnosed by a trained medical professional.

Depression

A mood disorder that causes a persistent feeling of sadness and loss of interest.

Disability

A physical or mental condition that limits a person’s movements, senses, or activities.

Insomnia

A sleep disorder, or disordered sleep pattern, characterized by trouble falling and/or staying asleep.

Overall well-being

The state of being comfortable, healthy, or happy; judging one’s own life positively; generally, “feeling good.”

Post-traumatic stress (PTS)

A normal adaptive response to traumatic or stressful life events that can result in a wide range of distressing symptoms. Post-traumatic stress disorder (PTSD) differs from PTS and is a clinical diagnosis.

Self-efficacy

An individual’s belief in their capacity to act in the ways necessary to reach specific goals.

Self-harm/suicidality

Deliberate injury to oneself as an emotional coping mechanism, ranging from cutting oneself to suicide. Expressions of self-harm and/or suicidality are usually considered an emergency and should be assessed and managed by a trained professional.

Social support

The perception that one is cared for, has assistance available if needed, and that one is part of a supportive social network.

Stress

Any type of change to one’s internal or external environment that causes physical, emotional, or psychological strain. “Managing stress” is an effort to return from this state of strain or disturbance to homeostasis or well-being.

Substance abuse

Use of a substance (usually drugs or alcohol) in amounts or by methods that are harmful to oneself or others. Substance use disorder (SUD) and addiction are distinct clinical diagnoses.

Trauma

Lasting biopsychosocial and/or emotional response that often results from experiencing a terrible event such as an accident, crime, military combat, or natural disaster, or a series of chronic traumatic events like persistent abuse or neglect.

Program beneficiary

Individual who receives program services; an entire group or population may be the recipient of services.

Service provider

Individual who directly provides services to another individual, group, or population (the “program beneficiary”) through a program.

Privacy Policy