Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Social Network Correlates of HCV and HIV Transmission Risk Behaviors among Injecting Drug Users Victor Emanuel Reyes-Ortiz Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, Psychiatric and Mental Health Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Victor Reyes-Ortiz has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Mary Lou Gutierrez, Committee Chairperson, Public Health Faculty Dr. Gary Burkholder, Committee Member, Public Health Faculty Dr. Margarita Alegría, Committee External Member, Harvard University Dr. JaMuir Robinson, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Social Network Correlates of HCV and HIV Transmission Risk Behaviors among Injecting Drug Users by Víctor Emanuel Reyes-Ortiz MS, University of Puerto Rico, 2006 BS MT, University of Puerto Rico, 2001 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2015 Abstract Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants’ personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self- reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality. Social Network Correlates of HCV and HIV Transmission Risk Behaviors among Injecting Drug Users by Víctor Emanuel Reyes Ortiz MS, University of Puerto Rico, 2006 BS MT, University of Puerto Rico, 2001 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2015 Dedication With great humility, I dedicate this work to the three most influential men in my life: Rev. Wilson De Jesús, Rev. Rafael "Rafy" Medina, and Dr. Rene Dávila-Torres, PhD, DBA. To them who taught me sacrifice, courage, and love for those around me that now are called community; their teachings were no less than public health. Acknowledgments I want to acknowledge all those who have been part of this success—those gone and those who are still here, making a better me. My family, Victor M. Reyes-Rivera and Nancy Ortiz Rivera, thanks for giving me the privilege of doubt. Once, you said to me, “Do you really think people will pay you for thinking and reading?” Well, now you see it. Not bad for a ghetto-boy. To Aricedly and Sonia, my beloved sisters, your support has been fundamental through all these years. José A. Ortiz, what can I tell you? Nothing more than THANKS. To my crew: Michelle Reyes-Robles, Santos Villaran-Gutierrez, Darleen González-Cortés, Jessenia Zayas-Ríos, Gabriel A. Vilella-Rivera, Sergio Fabián- Santiago, Crhistopher Orozco, Kenja Correa-Nivar, José Capriles-Quiroz, Ivelisse García-Meléndez, Mildred Pérez, Nirzka Labault-Cabeza, Miriam Márquez, Ana Parrilla, Luz E. León-López, Ana Luisa Dávila, Aida Font, Yaritza Morgado, José Gorrín-Peralta, Luz Muñiz de Meléndez, Glenda O. Dávila-Torres, Carmen Márquez, Adolfo Torres, Eladio Quintana, Quique & Gloria Alejandro, José García, Fam. Zambrano & Fam. Amézquita and the MPH class of 2011. All of you play a magnificent role in my life; without you guys, I’d have never done it. Believing is a strong power that you pour in others to make a better us; don’t stop believing. I also want to give thanks to the people of Dessources, Haiti, who gave me back hope when I went hopeless; you are the paradise, and I’ll never forget about you. To all the Latino communities in Cuba, Panamá, Honduras, El Salvador, New York, California, Texas, and Puerto Rico that allowed me to work within your houses, families, churches, hospitals, and elsewhere, no other words can be said beyond inspiration. Each of you inspired me to go forward and to try harder in each step. To the University of Puerto Rico IRB, which pushed me through all this process, you were some kind of fairy godmothers making all this better. To the following organizations, which also helped me through the hard times, making me to take out the best of me: Iniciativa Comunitaria e Investigación San Juan, PR; Arca del Refugio, Comerío, PR; Roca de Salvación, SFO, CA; and Casa de Paz, Las Piedras, PR. THANKS!! Last, I want to thank my committee for supporting me on each trip to Latino América, to the shooting galleries, to each congress and publication. Thanks to Dr. Burkholder who was patient, dedicated and showed me what should be a graduated mentor and not just a professor. I couldn’t believe your dedication was so strong that you didn’t have vacations, holydays, weekends or regular days; you only had Research Days. Dr. Alegría it has never been easy to do dissertatin but your guidance and questioning take me above and beyond my own expectations. Last, Dr. Gutiérez I’ll be in debt for all the hard working and the ever lasting converstations and couseling [even the fights] in this journey. To all of you thanks. I guess I have not been the “best grad” in a lifetime, but you have certainly been the best committee one could have. Lessons are forever … hope to keep you with me forever too. Table of Contents List of Tables .......................................................................................................................v Chapter 1: Introduction to the Study ....................................................................................1 Background of the Study ...............................................................................................1 Hepatitis C Epidemic .............................................................................................. 3 HIV Epidemic ......................................................................................................... 5 HCV and HIV Epidemic Interactions ..................................................................... 8 Social Network Characteristics ............................................................................... 9 Problem Statement .......................................................................................................12 Purpose of the Study ....................................................................................................13 Nature of the Study ......................................................................................................14 Research Questions and Hypotheses ...........................................................................14 Theoretical Base...........................................................................................................16 Definition of Terms......................................................................................................17 Assumptions .................................................................................................................19 Limitations ...................................................................................................................20 Delimitations ................................................................................................................20 Significance of the Study .............................................................................................21 Summary and Transition ..............................................................................................21 Chapter 2: Literature Review .............................................................................................23