Multilevel Modeling of Sexual Risk Behaviors, Social Network Members, and Sexual Health Communication Among Young Black Women Aged 18–25

Young Black women (YBW) are at high risk of HIV. Social networks have been shown to influence HIV risk among other high-risk populations, yet few HIV risk reduction studies have considered the impact of social network members (SNMs) on risk behaviors and sexual health communication of YBW. Egocentric social network data from 78 YBW aged 18 to 25 were collected to examine sexual health communication at the dyadic level between YBW and their SNMs (N = 1,052). Participants completed a self-administered questionnaire and social network interview. Multilevel multivariate logistic regression models assessed the association among individual sexual risk behaviors, SNM characteristics, and sexual health communication (i.e., communication about sex, condom use, and HIV testing). A majority of women were sexually active (85%), of whom 59% had sex during the previous 30 days. Women nominated an average of 14 SNMs. Friends were the most frequently nominated relationship type (55%). Regarding sexual health communication, YBW spoke to 55% of their SNMs about sex, 32% regarding condom use, and 21% regarding HIV testing. If SNMs provided emotional support to YBW, YBW were 4 times more likely to talk with SNMs about sex and HIV testing and 2 times more likely to talk to SNMs about condom use. Regarding communication via social media, YBW were 2.1 times more likely to talk about sex with SNMs who they spoke with via Facebook and 1.6 times more likely to talk about sex with SNMs who they spoke with via Snapchat. Furthermore, YBW were 1.8 times more likely to talk in person to SNMs about condom use. The results of this study provide the groundwork for future research geared toward HIV risk reduction among YBW and their SNMs. Although commonalities were found in terms of with whom YBW discuss sexual health (e.g., SNMs who provide emotional support), major differences emerged across sexual health topics. Depending on target outcomes for HIV intervention (increasing communication about sex, encouraging the use of condoms, and encouraging HIV testing), different strategies may be needed. These findings indicate that there may be no simple solution regarding the best means of delivering an intervention geared toward sexual health, nevertheless SNM relationships may be a leverage point for successful interventions.