Concordance of HIV Prevention Advocacy Reports and its Associations with HIV Protective Behaviors

TL;DR

This study explores how agreement between people living with HIV and their social network members on HIV prevention advocacy relates to safer sexual behaviors.

Contribution

The study identifies factors influencing concordance in HIV prevention advocacy reports and links this concordance to protective behaviors.

Findings

Concordance in condom advocacy was higher among romantic partners and lower when the index was younger.

Alters who concurred on condom advocacy had significantly higher odds of using condoms with their main partner.

Advocacy concordance was associated with increased HIV protective behaviors, suggesting the importance of shared perceptions.

Abstract

Peer advocacy can promote HIV protective behaviors, but little is known about the concordance on prevention advocacy(PA) reports between people living with HIV(PLWH) and their social network members. We examined prevalence and correlates of such concordance, and its association with the targeted HIV protective behavior of the social network member. Data were analyzed from 193 PLWH(index participants) and their 599 social network members(alters). Kappa statistics measured concordance between index and alter reports of PA in the past 3 months. Logistic and multinomial regressions evaluated the relationship between advocacy concordance and alter condom use and HIV testing behavior and correlates of PA concordance. Advocacy concordance was observed in 0.3% of index-alter dyads for PrEP discussion, 9% for condom use, 18% for HIV testing, 26% for care engagement, and 49% for antiretroviral use discussions. Fewer indexes reported condom use(23.5% vs. 28.1%;\documentclass[12pt]{minimal}
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\begin{document}$${ \chi }^{2}$$\end{document}=3.7, p=0.05) and HIV testing(30.5% vs. 50.5%; \documentclass[12pt]{minimal}
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\begin{document}$${\chi }^{2}$$\end{document}=25.3, p<0.001) PA occurring. Condom advocacy concordance was higher if the index and alter were romantic partners(OR=3.50; p=0.02), and lower if the index was 10 years younger than the alter(OR=0.23; p = 0.02). Alters had higher odds of using condoms with their main partner when both reported condom advocacy compared to dyads where neither reported advocacy(OR=3.90; p<0.001) and compared to dyads where only the index reported such advocacy(OR = 3.71; p=0.01). Age difference and relationship status impact advocacy agreement, and concordant perceptions of advocacy are linked to increased HIV protective behaviors. Alters’ perceptions may be crucial for behavior change, informing strategies for improving advocacy.