title: Network Location and Risk of Human Immunodeficiency Virus Transmission among Injecting Drug Users: Results of Multiple Membership Multilevel Modeling of Social Networks.
abstract: BACKGROUND
  Despite the implementation of harm reduction program, some injecting drug users (IDU) continue to engage in high-risk behaviors. It seems that there are some social factors that contribute to risk of human immunodeficiency virus (HIV) transmission in IDUs. The aim of this study was to analysis the social network of IDUs and examines the effect of network location on HIV transmission risk using the multiple membership multilevel models.
  
  
  METHODS
  From October 2013 to March 2014 we conducted face-to-face interviews on 147 IDUs. We asked participants to nominate up to 20 people whom they had more than causal contact with them during the last month and specify if each nominee is drug injector or not. We defined four Network locations as Core and Peripheries of main components. The risk of HIV transmission for each individual was measured based on 7 items scale. We applied Multiple Membership Multilevel Linear Regression analysis to examine the relationship between network location and HIV transmission risk. We used Stata and UCINET software's for the analysis of data.
  
  
  RESULTS
  The mean age of participants was 37 ± 9.32. Most of the individuals were male, single and educated up to guidance school. Being a core member of the main component as like as being a member of other small components in comparison with Isolates/unlinked significantly increased the HIV Transmission risk. Engagement in methadone maintenance therapies (MMT) was associated with a decrease in HIV transmission score.
  
  
  CONCLUSIONS
  Network analysis is a useful guide to find the most influential members of IDUs network and may have a complementary role for harm reduction program. The efficacy of interventions programs can be reinforced by addressing them to core individuals within the network. Furthermore, it provides the harm reduction staff to find the broader number of IDUs who are usually hard to reach by routine outreach case-finding tasks.
authors: PhD Candidate, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran AND Regional Knowledge Hub AND WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors: Armita
authors: A
authors: Shahesmaeili
authors: Professor, Department of Epidemiology, School of Public Health, Regional Knowledge Hub AND WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors: Ali Akbar
authors: AA
authors: Haghdoost
authors: Professor, Safety Promotion and Injury Prevention Research Center AND Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Hamid
authors: H
authors: Soori
keywords: Human immunodeficiency virus transmission risk; Injecting drug users; Iran; Network location; Social network analysis