Stigma, Social Networks, and HIV Testing, Linkage and Care

Drexel University, Philadelphia PA

Investigators

Abstract

This research seeks to understand how stigma affects a person's decision to test for HIV or adhere to care, and how the influence of stigma depends on an individual's social networks. Stigma remains one of the foremost barriers to effective HIV prevention, treatment and retention in care. HIV stigma undermines HIV prevention efforts by making it difficult for people to get tested for HIV, reduce their risk of infection, as well as seek and remain in care, if they are living with HIV. As a result, scholarly attention has centered on continuing refinement and conceptualization of stigma. Contemporary approaches to HIV-related stigma recognize the role of individual characteristics (such as their level of education, understanding of HIV, risk behaviors, etc.) and their social environments in shaping stigma and its experiences. However, stigma by definition is a byproduct of interpersonal relationships or an individual's social networks. An individual's relationships - whom they know, to whom they talk, in whom they confide, in fact, their social capital - are just as important in determining their propensity to stigmatize and be stigmatized. Unfortunately, scant attention has been paid to analyzing how stigma is shaped by the characteristics of the social networks of those enacting stigma and their targets. Insights from the project's findings will inform HIV prevention policies and programs as well as anti-stigma interventions and efforts to increase HIV testing and retention in care. The project also broadens participation of underrepresented groups in science, and trains undergraduate and graduate students from underrepresented groups. Dr. Emmanuel Koku of Drexel University will examine the effects of stigma and social capital on two health outcomes: getting tested for and adherence to HIV treatment. He and his research team will interview and conduct a social network survey with over 300 African immigrants (one of the fastest growing groups of migrants to the United States, and one that is increasingly at risk of HIV infection) in the greater Philadelphia area. They will (i) explore how HIV and its stigma is constructed, understood, and assigned in African immigrant communities, (2) document the experiences of stigma within the community, (3) analyze the influence of social networks and interpersonal relationships on experiences of stigma, HIV testing and adherence to care. Through these efforts, the proposed research will contribute to conceptualizations of stigma by linking it to social network theories, particularly social capital. The project's conceptual approach departs from dominant methodologies that view social capital as positive, evident in community norms of trust, reciprocity, and civic engagement. Conversely, the project examines how local and personal networks can be negatively constituted, influencing stigmatization within certain communities.