The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users.
OBJECTIVE
Social norms are a key source of influence on health behaviors. This study examined changes in social norms and relationships between HIV injection risk behaviors and social norms among injection drug users (IDUs) involved in an experimental intervention.


METHODS
Randomized clinical trial.


METHODS
An HIV Prevention Trials Network study, Philadelphia, USA.


METHODS
IDUs, called indexes, and their social network members, who were drug or sex partners, were recruited for an HIV prevention intervention and followed for up to 30 months (n = 652). Indexes were randomized into a peer education intervention or control condition.


METHODS
Outcomes of injection-related HIV risk behaviors (sharing needles, sharing cookers, sharing cotton, front-/back-loading) were measured every 6 months and the social norms of these four risk behaviors were assessed every 12 months.


RESULTS
There was a statistically significant intervention effect on all four social norms of injection behaviors, with participants in the intervention reporting less risky social norms compared with controls (changes in mean score: needles, -0.24, P = 0.007; cookers, -0.33, P = .004; cottons, -0.28, P = .0165; front-/back-loading, -0.23, P = .002). There was also a statistically significant bidirectional association with social norms predicting injection risk behaviors at the next assessment and risk behaviors predicting social norms at the subsequent visit.


CONCLUSIONS
Through social network interventions it is feasible to change both injection risk behaviors and associated social norms. However, it is critical that social network interventions focus on publically highlighting behavior changes, as changing social norms without awareness of behaviors change may lead to relapse of risk behaviors.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. clatkin@jhsph.edu
Carl
C
Latkin
Deborah
D
Donnell
Ting-Yuan
TY
Liu
Melissa
M
Davey-Rothwell
David
D
Celentano
David
D
Metzger
D000293:Adolescent; D000328:Adult; D055030:Drug Users / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000523:psychology; D015143:Philadelphia; D012309:Risk-Taking; D057566:Self Report; D012919:Social Behavior; D012931:Social Environment; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult