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Social Networks of Men Who Have Sex with Men: a Study of Recruitment Chains Using Respondent Driven Sampling in Salvador, Bahia State, Brazil

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Social Networks of Men Who Have Sex with Men: a Study of Recruitment Chains Using Respondent Driven Sampling in Salvador, Bahia State, Brazil S170 ARTIGO ARTICLE Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil Redes sociais de homens que fazem sexo com homens: estudo das cadeias de recrutamento com Respondent Driven Sampling em Salvador, Bahia, Brasil Las redes sociales de hombres que mantienen sexo con hombres: estudio de muestreo en Sandra Mara Silva Brignol 1 cadena con Respondent Driven Sampling Inês Dourado 1 Leila Denise Amorim 2 en Salvador, Bahía, Brasil José Garcia Vivas Miranda 3 Lígia R. F. S. Kerr 4 Abstract Resumo 1 Instituto de Saúde Coletiva, Social and sexual contact networks between men As redes sociais e de contato sexual entre homens Universidade Federal da Bahia, Salvador, Brasil. who have sex with men (MSM) play an impor- que fazem sexo com homens (HSH) têm um pa- 2 Instituto de Matemática, tant role in understanding the transmission of pel importante na compreensão da ocorrência de Universidade Federal da HIV and other sexually transmitted infections doenças sexualmente transmissíveis (DST) e HIV, Bahia, Salvador, Brasil. 3 Instituto de Física, (STIs). In Salvador (Bahia State, Brazil), one of devido ao potencial de circulação de agentes in- Universidade Federal da the cities in the survey Behavior, Attitudes, Prac- fecciosos nestas estruturas. Dados da Cidade de Bahia, Salvador, Brasil. tices, and Prevalence of HIV and Syphilis among Salvador, Bahia, Brasil, que integraram a pesquisa 4 Faculdade de Medicina, Universidade Federal da Men Who Have Sex with Men in 10 Brazilian Comportamento, Atitudes, Práticas e Prevalência Ceará, Fortaleza, Brasil. Cities, data were collected in 2008/2009 from a de HIV e Sífilis entre Homens que Fazem Sexo sample of 383 MSM using Respondent Driven com Homens em 10 Cidades Brasileiras foram Correspondence S. M. S. Brignol Sampling (RDS). Network analysis was used to coletados em 2009 numa amostra de 383 HSH Instituto de Saúde Coletiva, study friendship networks and sexual partner por meio da técnica Respondent Driven Sampling Universidade Federal da networks. The study also focused on the associa- (RDS). Análise de redes sociais foi utilizada para Bahia. Rua Padre Feijó s/n, Campus tion between the number of links (degree) and investigar as redes de amigos e parceiros sexuais. Universitário do Canela, the number of sexual partners, in addition to Também foi avaliada a relação entre o número de Salvador, BA 40110-040, Brasil. socio-demographic characteristics. The networks’ conexões (grau) o número de parceiros sexuais e as [email protected] structure potentially facilitates HIV transmis- características sociodemográficas. As redes apre- sion. However, the same networks can also be sentaram estruturas que facilitam a transmissão used to spread messages on STI/HIV prevention, do HIV. Porém, podem ser exploradas para a disse- since the proximity and similarity of MSM in minação de informações sobre a prevenção do HIV these networks can encourage behavior change e DST, visto que a proximidade e similaridade dos and positive attitudes towards prevention. HSH nessas redes podem influenciar comporta- mentos e atitudes positivas para a prevenção. Male Homosexuality; Sexual Behavior; HIV; Social Networking Homossexualidade Masculina; Redes Sociais; HIV; Comportamento Sexual Cad. Saúde Pública, Rio de Janeiro, 31 Sup:S170-S181, 2015 http://dx.doi.org/10.1590/0102-311X00085614 SOCIAL NETWORKS OF MEN WHO HAVE SEX WITH MEN S171 The organization of the homosexual/gay com- These networks provide not only the possibility munity and identity in large Brazilian cities took for socialization and homoerotic activities but place within the historical context of the social, also mobility and social support 2,3,4,5,12. Accord- economic, and political changes that shaped the ing to some researchers, these networks branch country’s demographic transition beginning in out, overlap, and intersect, leading to interac- the 1950s 1,2. However, homosexuals migrated tion between individuals from different social to Brazilian cities during this period for reasons classes and social positions, and areas of the other than the economic motivation that char- city, via intense mobility: from the city center acterized migration by the general population. to the periphery, across metropolitan areas, Such factors included placing a distance be- from the countryside to the capital cities, from tween themselves and family surveillance and small to large cities, and between geographic social repression, as well as the search for ano- regions 3,4,5,12. nymity, homosexual/gay sociability, and sexual Social scientists have studied the organi- freedom 3,4,5,6. zation of relations in social networks since the The “political opening” of the 1970s and 1930s 13. In physics, network theory was sys- 1980s 3,4 included an increasing struggle for sex- tematized and presented in the 1950s 14 and ual rights and greater visibility for the homosex- has advanced over the years with the identifica- ual world and influenced the migration of gays tion of different patterns in these structures 15. to Brazil’s large cities, especially São Paulo and Researchers developed a series of theories that Rio de Janeiro, with growth in the “ghettos” of included random networks 14, small-world net- homosexual/gay circulation and sociability 3,4,5. works 16, and scale-free networks 17, identified This movement led to greater visibility for gay in the late 1990s, that help explain the networks’ identity and culture 3,4,5,6. In addition to the various characteristics and functioning, with country’s overall political and social gains in re- their potentialities and vulnerabilities 15,18. cent decades, public policies for human rights It is now widely accepted that humans are were created and consolidated 7,8. Meanwhile, connected through a large network of social re- this same visibility brought other consequenc- lationships 13,15,16,17. People connect by strong or es such as the stigma, discrimination, and close ties with friends and relatives, as well by violence that mark the daily lives of many gay weaker ties (indirectly) with friends of friends, Brazilians 9,10, even in the large cities, in a society or with acquaintances, distant relatives, former that has proven historically intolerant to homo- coworkers, and neighbors 15,16. Considering this sexuality 10,11. configuration of relationships, human beings are The difficulties in living in large Brazilian cit- separated from each other by an average of six ies, with poor quality of services in transportation, degrees, that is, six persons, but these influences public security, education, and health, affects all occur most intensely within three degrees (the so- urban Brazilians 1,2, including men who have sex called “three degrees of influence” rule) 15. Recent with men (MSM), whether openly homosexual/ studies have analyzed sexual contact networks gay men or men with a heterosexual social iden- of MSM in the context of HIV and other sexu- tity and homoerotic practices. In addition, many ally transmitted infections 19. The importance of areas of the large cities lack major public services, these networks is due mainly to the circulation thus creating an underlying social vulnerability of infectious agents, with the potential for rapid in the rapid urbanization process that Brazil has transmission in large sexual partner networks in experienced since the mid-20th century 1,2. the presence of risky sexual practices such as un- Urban health is a branch of public health protected sex, especially between serodiscordant that studies risk factors in cities and the effects individuals 19. on health and social relations 1,2. In this context, As in other populations, MSM are connected the organization of social networks in communi- through different social networks (friends, sexual ties as a form of local support and empowerment partners, and individuals that frequent public highlights the importance of such structures in and private venues for gay sociability) 3,4,5,6,12. the context of the urban population’s health. A But they also connect with men that identify as major challenge for public health is thus to un- heterosexuals but have homoerotic and sexual derstand the role and influence of these networks practices with other men 3,4,5,6,12. It is thus dif- and their relationship to health issues 2. ficult to organize a mapping or census of MSM, As in other contexts, in homosexual/gay so- or a random sample, due to issues of stigma, dis- ciability, social networks serve as a form of sup- crimination, criminalization of sexual practices, port for individuals, with different types of “net- and the diversity of social venues. works” (friendship, community based organiza- This study focus on a sample of MSM in Bra- tion, and cultural and sexual networks) 3,4,5,6,12. zil’s third largest city 20, with the following objec- Cad. Saúde Pública, Rio de Janeiro, 31 Sup:S170-S181, 2015 S172 Brignol SMS et al. tives: (1) to identify the network structure among (friends and sexual partners). In Salvador, 394 the participants’ closest friends and sexual part- MSM were recruited, of whom 383 met the in- ners and (2) to analyze the associations between clusion criteria and comprised the final study the number of links between study participants sample 27 (Figure 1). (degree) and the number of sexual partners, and with key socio-demographic characteristics. Study variables Salvador, the capital of Bahia State, like other large Brazilian cities, suffers from
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