Social networks and HIV prevention: Qualitative Insights from an Intervention with Male Clients of Female Sex Workers in Santo Domingo, Dominican Republic

Purpose: Male clients of female sex workers are rarely engaged in HIV prevention interventions despite their power in condom negotiation. Previous research in the Dominican Republic found that male clients' social networks may provide a naturally existing tool for HIV prevention. The purpose of the current study was to examine the experience of male clients trained as peer educators, called voluntarios, to promote HIV protective behaviors within their social networks.

Methods: We conducted qualitative interviews using a semi-structured guide with 17 purposively sampled voluntarios. Interview topics included project experiences, social networks, and sexual behavior. We developed topical codes, applied them to text with Atlas.tiŠ, and summarized outputs with matrices.

Results: Participants indicated improved knowledge about HIV transmission and condom use skills as personal benefits of being a voluntario. There were few examples, however, of voluntarios taking a leadership role in project activities; instead, most provided logistical support to female sex worker peer educators. Participants displayed more comfort providing HIV-related information to men through outreach activities rather than ongoing discussion with social network contacts. Within their social networks, voluntarios described advising about what men should do to prevent HIV transmission more often than discussing their personal experiences.

Conclusions: Findings indicate that while voluntarios appreciate obtaining new information and participating in HIV prevention efforts, they do not automatically assume a leadership role or engage their personal network ties. Future efforts should develop leadership and communication skills so that men can initiate and sustain promotion of HIV protective behaviors within their social networks.