Talking the Talk, Walking the Walk: Social Network Norms, Communication Patterns, and Condom Use among the Male Partners of Female Sex Workers in La Romana, Dominican Republic

This article, available through the National Institutes of Health (NIH) of the United States, discusses male partners of female sex workers, recognising their central role and power in condom use negotiation. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic (DR). This study sought to understand how the dynamics of social influence processes among men may abet or impede sexual risk reduction practices in order to develop more effective HIV prevention interventions.

Non-governmental organisations (NGOs) the Centro de Orientación e Investigación Integral and the Centro de Promoción y Solidaridad Humana implemented "an environmental-structural intervention integrating community solidarity and government policy strategies", attempting to use social networks which offer a naturally existing social structure to increase male participation in preventing HIV. They have also utilised theatre and street outreach to reach men. This study attempted to evaluate the influence of social networks on HIV risk behaviours.

HIV prevalence among 15 to 49 year-olds in the DR is estimated to be 1.0%. Heterosexual sex is the most common route of transmission, accounting for 76.0% of HIV cases. The most recent HIV prevalence estimates for La Romana indicate HIV 4.7% prevalence among female sex workers. Male partners (n=318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioural outcome sought for measurement was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months.

In short, the study measured:

• Consistent condom use with most recent regular female sex worker partner
  
• Social network characteristics
  
• Communication about condoms
  
• Social network norms
  
• Individual and relational factors
  

Results showed that men reported small, dense networks with high levels of communication about condoms and consistent condom use. Nearly 60% of participants reported receiving high levels of social support from all of their social network contacts, and 70.4% reported receiving encouragement to use condoms from all social network contacts. The majority of men also perceived that at least some of their male social network contacts always used condoms with regular female sex worker partners and provided encouragement to use condoms. "Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members."

The Abstract provides the following conclusion: "Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners."