The complex interplay of social networks, geography and HIV risk among Malaysian Drug Injectors: Results from respondent-driven sampling

Zelenev, A. and Long, E. and Bazazi, A.R. and Kamarulzaman, A. and Altice, F.L. (2016) The complex interplay of social networks, geography and HIV risk among Malaysian Drug Injectors: Results from respondent-driven sampling. International Journal of Drug Policy, 37. pp. 98-106. ISSN 0955-3959, DOI

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Background HIV is primarily concentrated among people who inject drugs (PWID) in Malaysia, where currently HIV prevention and treatment coverage is inadequate. To improve the targeting of interventions, we examined HIV clustering and the role that social networks and geographical distance play in influencing HIV transmission among PWID. Methods Data were derived from a respondent-driven survey sample (RDS) collected during 2010 of 460 PWID in greater Kuala Lumpur. Analysis focused on socio-demographic, clinical, behavioural, and network information. Spatial probit models were developed based on a distinction between the influence of peers (individuals nominated through a recruitment network) and neighbours (residing a close distance to the individual). The models were expanded to account for the potential influence of the network formation. Results Recruitment patterns of HIV-infected PWID clustered both spatially and across the recruitment networks. In addition, HIV-infected PWID were more likely to have peers and neighbours who inject with clean needles were HIV-infected and lived nearby (<5 km), more likely to have been previously incarcerated, less likely to use clean needles (26.8% vs 53.0% of the reported injections, p < 0.01), and have fewer recent injection partners (2.4 vs 5.4, p < 0.01). The association between the HIV status of peers and neighbours remained significantly correlated even after controlling for unobserved variation related to network formation and sero-sorting. Conclusion The relationship between HIV status across networks and space in Kuala Lumpur underscores the importance of these factors for surveillance and prevention strategies, and this needs to be more closely integrated. RDS can be applied to identify injection network structures, and this provides an important mechanism for improving public health surveillance, accessing high-risk populations, and implementing risk-reduction interventions to slow HIV transmission.

Item Type: Article
Funders: NIH career development (K01 DA037826 for AZ, K24 DA017072 for FLA and F30 DA039716 for ARB), research (NIDA R01 DA025943 for FLA), and training (T32GM07205, T32MH020031 for ARB) grants, University of Malaya’s High Impact Research Grant (E-000001-20001; AK), Yale Downs Fellowship (ARB)
Uncontrolled Keywords: HIV; Malaysia; Social networks; Geography; Respondent-driven sampling; Addiction; People who inject drugs (PWID)
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 15 May 2018 04:25
Last Modified: 15 May 2018 04:25

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