Influence of Social Network on HIV Risk Behaviors among Methadone Maintenance Treatment (MMT) Clients in Kunming china

Abstract

Background: In the 1990s, mainland China introduced the Methadone Maintenance Treatment (MMT) program to cope with the rapidly rising number of heroin users and related increases in the prevalence of HIV. Currently, China's MMT program is the largest in the world. However, many MMT clients continue to engage in drug-using behaviors during treatment, resulting in high drop-out rates. Many studies have revealed factors associated with concurrent drug use among the clients. But these studies examined only individual factors; only few included interpersonal network factors. This study aims to describe the characteristics of the social network and the HIV risk behaviors among MMT clients, and evaluate the influence of social networks and their relationships with client's HIV risk behaviors. The information obtained from this study may be useful for designing social influence strategies for HIV/AIDS preventive interventions in MMT programs. Methods: This cross-sectional survey was conducted in Kunming city, Yunnan province, China. A total of 324 participants were consecutively recruited from four out of 11 randomly sampled MMT clinics in 2016. The four selected clinics treat over 200 clients per day and are distributed in different parts of the city. The interviews took on average about 50 minutes to complete. Demographic information collected included age, gender, religion, marital status, education, ethnic group, occupation, and current employment. Use of alcohol, opium, heroin, morphine and other drugs in the past 30 days were also collected. Data on social support networks were collected with a set of questions enquiring about the MMT client's relationships with people in his/her own social network. After the interview, a urine specimen was collected and tested immediately for opiate metabolites. If a participant had a positive urine test result, he or she was considered as a current heroin user. Social network analysis was used to investigate the structures of the client's social network. Results: In total, 324 clients from four clinics were investigated. The mean age was 45.2 years and 54.6% were aged between 40 and 49 years, 76.9% were male, and 12.7% were single. More than half of the participants (58.4%) had completed primary school or junior high school, 36.8% were unemployed, 18.5% were HIV positive and 11.4% were taking antiretroviral treatment. More than a quarter (25.9%) had a positive urine test and thus considered to be using heroin. MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00, 1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86, 14.65) and any member joined them in using drugs (AOR 1.94, 95% CI = 1.04, 3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03, 0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24, 0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09, 0.90) were associated with a decreased odds of heroin use. Conclusion: Social network members who could provide MMT clients with emotional support and had a close relationship with them were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients. In the social network analysis, the high degree members in the social network among MMT clients should be noted as leaders of health peer education for HIV prevention and intervention.