Diffusion of HIV Prevention Advocacy in Social Networks of Persons Living with HIV in Uganda

BACKGROUND: Peer advocacy has been shown to influence HIV protective behaviors, but few studies have examined whether advocacy within social networks is diffused-a process whereby the recipient of advocacy engages in further advocacy with others. Advocacy diffusion is critical for wide dissemination of knowledge and behavioral change throughout a network. METHOD: In a randomized controlled trial of a peer advocacy training intervention for people living with HIV (PLWH) in urban Uganda, 210 PLWH were enrolled as index participants along with 599 of their social network members (alter participants), all of whom were assessed at baseline and months 6, 12 and 18. Prevention advocacy engagement was assessed with a 10-item scale of frequency of discussion of various HIV prevention topics with others in the past 3 months. Repeated-measures linear regression models examined predictors of change in HIV prevention advocacy engagement among 596 alters who completed at least one follow-up assessment. RESULTS: Alter engagement in HIV prevention advocacy increased significantly across follow-up (from 2.08 at baseline to 3.53 at month 18; possible range: 1-5), and this increase was predicted by general increased engagement in advocacy reported by the index participant who recruited them, receipt of any behavior-specific advocacy from this index, older age, and greater HIV disclosure (if the alter was living with HIV). CONCLUSION: These findings provide evidence of an initial step of HIV prevention advocacy diffusion from index to first-degree alter, thereby highlighting the possibility of diffusion throughout the wider network and the potential for scaled-up dissemination of knowledge and behavior change for HIV prevention.