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Contributed Papers
Michael Bracher, Susan Watkins and Gigi Santow How important are high-risk groups for maintaining the momentum of the HIV/AIDS epidemic? HIV/AIDS interventions have typically targeted high-risk groups, which
in
In this paper we employ microsimulation to examine the rapidity with
which
R.S. Goyal, Satish Kumar, Sunita Nigam
Promoting Sexual Health Through Dialogue Between Men And Women Within Social Networks This paper presents the findings of an operations research study undertaken to assess the perception, attitude and behaviour of men and women towards sexual health, to understand their information needs on this subject and, to meet these need through dialogue between men and women within same social network. The project was sponsored by Family Health International, USA. Against the backdrop of a low literacy level and limited exposure to mass-media, interpersonal communication i.e., `dialogue’ within and between the sexes could be an effective tool to achieve behaviour change. The dialogue would be more effective within the members of same social network, because the social pressures for attitudinal and behavioural modifications would be more strong in such settings. The project was implemented in one rural and one urban localities of Jaipur district (India) in the middle of 1997. The study showed that both men and women had a very poor perception of their sexual health and sexual health needs. After initial hesitation, both men and women could frankly discuss sexual health and related issues in dialogue sessions of people of the same sex and of both sexes. The community response to these initiatives was very positive. The elders in the family (particularly mother-in-low) were initially hesitant to permit their daughters-in-law to participate in the dialogue sessions particularly of both sexes, but they agreed on persuasion. There was a large and effective diffusion of `dialogue’ in the community at large. The study shows that dialogue is an effective mode to promote sharing
of perceptions and experiences among men and women. It is also effective
in creating awareness and validating scientific knowledge. It is
particularly helpful to people in understanding ones own and appreciating
others’ (opposite sex) sexuality. It also contribute to modifying
opinions and attitudes of men and women towards safe sex. More importantly,
dialogue has helped in creating a positive environment for adoption of
safe sex practises and strengthen the women’s ability to negotiate for
less violent and safe sex, within the married unions.
Simon Gregson, Constance Nyamukapa, Geoffrey P. Garnett, Tom Zhuwau, Violet Matimba-Masuku, Roy M. Anderson and Stephen K. Chandiwana Sexual Behaviour Patterns and the Rapid Rise in Age-Specific HIV-1 Prevalence among Young Women in Rural Zimbabwe Background: A population survey of HIV and associated patterns
of sexual behaviour is currently in progress in rural areas of Manicaland
Province, Zimbabwe. Early results indicate that HIV prevalence increases
very rapidly between the ages of 16 and 25 in women but more slowly and
at later ages among men. A part of the explanation for the contrasting
age-pattern of infection lies in higher male-female than female-male HIV
transmission probabilities. However, differences in patterns of sexual
behaviour between young men and young women could be a further contributing
factor.
Laura Koehly, Martina Morris and Steve Goodreau Random Graph Models for Contact Networks: Loglinear models, Logit models and P* Morris (1991) introduced log-linear models as a method for representing
selective and proportional mixing in partner contact matrices. These
models assume dyadic independence, and thus ignore micro-level relational
structure. The p* models recently described by Wasserman
and Pattison (1996), provide a more general framework for modeling partnership
structure. This approach allows for more sophisticated modeling of
the social interactions among network members, while simultaneously accounting
for partnership attribute composition. The loglinear models can be
shown as special cases of the more general random graph models represented
by p*. The common exponential form makes it possible to use
this modeling framework to investigate the role of network microstructures
and aggregate mixing biases on disease transmission dynamics.
Hans-Peter Kohler, Jere Behrman and Susan Watkins The Determinants of Partners for Conversations about AIDS In this paper we consider the selection of partners for conversations about AIDS, using data from Kenya and Malawi. We do this by comparing the determinants of network characteristics for AIDS and family planning conversational networks. We develop a theoretical model of these determinants, and estimate it using data from household surveys conducted in rural areas (approximately 800 women and their husbands in Kenya, and 1600 women and their husbands in Malawi) as well as qualitative interviews (some of which will be conducted in June-July 1999). In both countries, high proportions of both men and women have talked with others about both family planning and AIDS (for example, in Malawi 94% of men and 84% of women had talked with other people about AIDS, with a slightly lower proportion talking about family planning). To a considerable degree, network partners are homophilous: they are local, and approximately 50% in both types of networks are confidants (with the rest being friends or, a smaller proportion, acquaintances). And both networks are dense: the network partners know each other. AIDS networks are, however, somewhat larger and younger than family planning networks, and the network partners have a slightly higher level of education. The qualitative data show that to a considerable extent these conversations occur casually rather than purposefully, in the course of conversations which may cover a range of topics. Yet the differences in the network characteristics and the qualitative data suggest that some women and men choose at least some of their network partners deliberately, either because they are expected to have relevant experience or knowledge, or because the respondent wants to gauge their opinion (e.g. of the morality of using modern family planning or condoms). To the extent that network partners are deliberately selected, it would appear likely that different selection criteria come into play. AIDS and family planning networks appear to be similar in that for both
what is relevant is social learning and social influence about an innovation
(modern contraception and aids prevention behavior): the individual is
seeking an answer to the question "what do you do given that you intend
to limit/space births (in fp) or prevent AIDS with a potentially effected
partner. They differ, however, in that an important additional aspect
of AIDS conversations appears to be the evaluation of risk groups within
a community. Qualitative interviews conducted in rural areas in both
countries suggest that for many neither strict marital fidelity nor regular
condom use are acceptable; rather, those considering extramarital sex and/or
condom use turn to others in order to attempt to estimate the likelihood
that a particular potential partner is infected, and thus whether the partner
should be avoided or whether condoms should be used, and for how long.
There appears to be general agreement of levels of risk: for example, women
from the large cities are risky, as are bar girls, but village women are
less likely to be infected. If these expectations are correct, we
should find that the respondents' mental models for choosing conversational
partners for discussions of AIDS should be different from their models
for discussions of family planning.
James Moody
Indirect Connectivity and STD Infection Risk: The Importance of Relationship Timing for STD Diffusion. Sexual networks have a peculiar temporal feature: while each dyadic
relationship is symmetric, the indirect relations implied by partners of
partners are not symmetric. Indirect asymmetry follows from the fact
that infections can only flow forward through time-ordered paths.
Thus, one's past partners are not at risk to one's current infection while
one's future partners are. This temporal ordering is a key element
needed to understand disease diffusion in the population. Depending
on the timing of relations, the same contact network may result in dramatically
different sets of people exposed to the STD. In this paper, I first
show how the timing of sexual relations determines potential exposure and
provide a method for deriving upper and lower bounds for indirect contact
within networks of a known structure. I then apply the method to
data on romantic and sexual networks in the United States, showing how
relationship timing both limits the ultimate exposure within the network
and creates pools of people who are mutually connected indirectly, thus
forming pockets where an STD could circulate. This work implies that
understanding STD diffusion requires collecting data on the timing as well
as the pattern of sexual relations.
Soori Nnko, Ties Boerma, Mark Urassa, Basia Zaba Sexual networking in Kisesa, Tanzania In 1994 a cohort study was initiated in Kisesa community in northwest Tanzania. A survey including all adults 15-44 years was carried out in 1994/95 and repeated again in 1996/97. Both surveys included a series of questions on marital and sexual behaviour of the respondent, including number of sexual partners in the last month and in the last year. During the second survey a sexual networking module was added to the general questionnaire and was administered at the end of the interview. The questionnaire was adapted from the UNAIDS module for tracing sexual networks. Questions about the partnership characteristics were limited to the last five partners during the last 12 months. Data were also collected on HIV status in both survey rounds. In total 3,700 respondents were asked the questions on sexual partnerships. 58% of sexuall active men and 22% sexually active women reported at least one non-marital non-cohabiting partnership. Among those who reported at least one partnership the average number of partnerships was 2.1 for men and 1.2 for women. The analysis will describe the sexual networking patterns in Kisesa.
In the first part the patterns of mixing are described: by age, by marital
status, by place of residence, etc. Measures of concurrency will be presented.
In the second part, special attention will be paid to the assessment of
the validity of data on multiple partnerships reported by men and by women.
Even though women report much lower frequencies of multiple partnerships
preliminary analysis indicates that women's partnership patterns are potentially
a more sensitive indicator of sexual networking in the population than
the corresponding male data. In particular, the assessment will focus on
changes in partnership patterns by sex of the respondent as an indicator
of changes in sexual behaviour and the risk of HIV.
I.O. Orubuloye
Researching sexual behaviour and identifying sexual networks in the shadow of AIDS in Nigeria. Before the advent of the AIDS epidemic, there was very limited research
on sexuality and sexual relations. Earlier social science researchers were
reluctant to investigate pattern of sexual behaviour because of the sensitivity
of the topic and the fear of hurting their respondents and thus jeopardizing
future research. The AIDS epidemic in Africa has given rise to a need for
research into sexual behaviour ans sexual networks because of the heterosexual
nature of the epidemic. Since 1989 the West African Research Group
on Sexual Networking consisting of researchers from Ghana, Nigeria and
Uganda has been investigating how many different sexual partners men and
women have both inside and outside marriage and how such relationships
are distributed overtime. The paper will report on how the studies were
conceived, how the survey instuments were developed and tested and the
various methodological approaches adopted in investigating these relationships
among the general population and specific high risk groups such as sex
workers, truck drivers, women traders, prison population, police etc. The
problems and methodological advances in the social context of the AIDS
epidemic will also be discussed.
Alex Weinreb
Interviewer Effects in Network Studies This paper examines the effect of interviewers knowing their respondents
in network studies on social relationships and personal behavior.
Three findings emerge. First, insider-interviewers were much more
successful in getting data on network partners. Second, a substantial
amount of response variance on critical dependent variables was associated
with the difference in interviewer-stimulus (ie. insiders vs. strangers,
men vs. women). And third, the joint effect of these two factors
in analysis leads to the estimation of radically different coefficients
on certain network characteristics when the contribution of different types
of interviewers to the data is empahasized. This implies that results
are contingent on the type of interviewer that is used, not a surprise
but certainly worth bearing in mind given the norm of using stranger-interviewers
in survey research.
Helene A.C.M. Voeten1, E.I. Meester1,
O.B. Egesah2, J.D.F. Habbema1
Possibilities and impossibilities of method triangulation in the study of sexual networks The Department of Public Health of the Erasmus University Rotterdam in the Netherlands has developed a micro-simulation model called STDSIM, as a tool to support decision-makers and health planners in the prioritisation of STD/HIV interventions. Nairobi and the rural province of Nyanza in Kenya have been first sites of application. To fill in gaps of knowledge and to quantify the model, applied research has been set up in Nyanza beginning of 1999, focusing on sexual behaviour patterns and networks of young adults aged 15-29, commercial sex workers and their clients. The following multiple methods were used: 1) household based study of young adults: questionnaires followed by in-depth interviews with a sub-set of the same respondents; 2) CSWs: focus group discussions followed by either a questionnaire or an in-depth interview, which were again followed by a 2-weeks sexual diary keeping; 3) CSW clients: informal discussions mainly in bars. Data were/are being analysed with Epi-Info, SPSS and NUD*IST (package for qualitative analyses). In addition, qualitative data (focus group discussions, in-depth interviews and informal discussions) have been translated into quantitative data-sheets, to enable comparison of data. The aim of using multiple methods to investigate the same population on the same/overlapping issues (method triangulation), was to gain thorough insights in the sexual networks and to validate the self-reports from surveys. A number of difficulties were encountered in the CSW data-analyses process, and these will be discussed here. Notwithstanding these difficulties, method triangulation can be useful in sexual network research:
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