Social network recruitment for undiagnosed HIV

Have you recently tested positive for HIV? Are there people in your social network (friends, family, sexual partners) that you would refer for HIV testing?

If you answered yes to the first question, then compared to the general population you are three times more likely to refer someone who will test positive for HIV.

A study conducted in Malawi, published in the Journal of Acquired Immune Deficiency Syndrome, has found that social contacts of people living with HIV are key to identifying those who are HIV positive and unaware of their status.

In Malawi, the prevalence of HIV is 11 percent, but nearly a third of people are not aware of their positive status. More needs to be done to reach the undiagnosed.

In the study, conducted at Kamuzu Central Hospital, there were three groups of 45 people each. One group had people recently diagnosed with HIV, another group had people with a sexual transmitted infection (STI) but not HIV and the third group had people with neither HIV or an STI. Each group was asked to recruit for a ‘health promotion programme’ five people from their network – they could be a family member, a friend or a sexual partner.

Thirty one percent of the people referred to by the group of people living with HIV tested positive for HIV compared to 11 percent of those referred by the group that had neither a STI or HIV. Another way of looking at it is – 1 out of 8 of people referred by people with HIV would test positive for HIV compared to 1 in 10 contacts for people with STI compared to 1 in 18 contacts from people who have neither HIV nor an STI.

The thing I was extremely curious about, which the study authors don’t discuss in detail, is how the people in the study encouraged their friends or family members to participate in the “health promotion programme”. Are some strategies more effective than others in convincing peers and family members to visit the hospital for a “health promotion programme”.

Because anyone who has tried knows that it is not easy convincing someone to go for an HIV test. In the study, they did pay expenses to participants such as the equivalent of $5 (about K2 600) for transport and $2 (K820) for every person successfully referred.

Would larger amounts of money support referral of higher risk persons? How many kwachas can encourage people to successfully refer someone for testing? A complication, however, of this social network recruitment is the risk of unintentional disclosure of the status of the person who is doing the referring.

All in all, what does this mean? People who engage in risky sexual behaviour are more likely to be in the same social network. The implication for this is the potential to develop strategies to reach undiagnosed and hard to reach cases of HIV.