Date of Award

Summer 5-2019

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

PATRICIA DOLAN MULLEN, DRPH

Second Advisor

KAYO FUJIMOTO, PHD

Third Advisor

MARIA FERNANDEZ-ESQUER, PHD

Abstract

While incidence of HIV has decreased overall and in most population subgroups, men who have sex with men (MSM) continue to remain at disproportional risk for new infection. In particular, MSM of color experience HIV incidence rates that continue to rise and represent the overwhelming majority of new cases each year. Evidence suggests greater risk among MSM may not be attributable primarily to individual behavioral level factors, but instead to structural and social environmental level factors such as access to health services. Access to health services represents a critical link in HIV and STI prevention, as health services provide serological testing and preventive treatments such as PrEP, along with access to therapies such as ART which can reduce viral load. It has been documented that MSM have reduced access to health services (include preventive health services), which manifest as a potential risk factor for increased transmission downstream because of the role health services play in prevention. This dissertation investigates the relation between social capital and health services awareness and utilization among MSM, to being to elucidate the potential role the social environment can play for these important transmission-reducing outcomes. Aim 1 examines the relation between two different kinds of social capital, bonding social capital and bridging social capital, with the outcomes of health services resource awareness and utilization of health services. Aim 2 investigates a potential effect modification, assessing the moderation of individual level social capital on the relation between community level social capital and health services awareness and utilization. Aim 3 is a systematic review covering characteristics of social network interventions for risk reduction in MSM and how these interventions are implemented. For Aim 1, results indicated bridging social capital was significantly associated with the outcome of health venue awareness in the Chicago MSM community, while bonding social capital was significantly associated with both health venue awareness and utilization in the Houston site. Aim 2 results provided evidence suggesting a significant moderation effect from individual level social capital on the relation between community level social capital and health venue awareness in both study sites. Major trends observed from the systematic review on social network interventions (Aim 3) include lack of definitions for what constitutes a social network intervention, no established standards or best practices for network change agent determination, and lack of reporting for network outcomes, properties, and intervention characteristics.

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