Abstract
Control of sexually transmitted infections and blood-borne pathogens is challenging due to their presence in groups exhibiting complex social interactions. In particular, sharing injection drug use equipment and selling sex (prostitution) puts people at high risk. Previous work examining the involvement of risk behaviours in social networks has suggested that social and geographic distance of persons within a group contributes to these pathogens’ endemicity. In this study, we examine the role of place in the connectedness of street people, selected by respondent driven sampling, in the transmission of blood-borne and sexually transmitted pathogens. A sample of 600 injection drug users, men who have sex with men, street youth and homeless people were recruited in Winnipeg, Canada from January to December, 2009. The residences of participants and those of their social connections were linked to each other and to locations where they engaged in risk activity. Survey responses identified 101 unique sites where respondents participated in injection drug use or sex transactions. Risk sites and respondents’ residences were geocoded, with residence representing the individuals. The sociospatial network and estimations of geographic areas most likely to be frequented were mapped with network graphs and spatially using a Geographic Information System (GIS). The network with the most nodes connected 7.7% of respondents; consideration of the sociospatial network increased this to 49.7%. The mean distance between any two locations in the network was within 3.5 kilometres. Kernel density estimation revealed key activity spaces where the five largest networks overlapped. Here, the combination of spatial and social entities in network analysis defines the overlap of vulnerable populations in risk space, over and above the person to person links. Implications of this work are far reaching, not just for understanding transmission dynamics of sexually transmitted infections by identifying activity “hotspots” and their intersection with each social network, but also for the spread of other diseases (e.g. tuberculosis) and targeting prevention services.
Highlights
Transmitted infections (STIs; such as chlamydia, gonorrhea, and infectious syphilis) and blood-borne pathogens (BBPs; HIV and Hepatitis C) are treatable diseases that are concentrated in very small segments of our populations [1,2,3,4]
Serological testing for STIs and BBPs was refused by 13.2% of respondents
Of those who consented to tests, laboratory results showed 8.0% infected with HIV; 28.2% infected with Hepatitis C (HCV); 3.5% with chlamydia; 0.8% with syphilis
Summary
Transmitted infections (STIs; such as chlamydia, gonorrhea, and infectious syphilis) and blood-borne pathogens (BBPs; HIV and Hepatitis C) are treatable diseases that are concentrated in very small segments of our populations [1,2,3,4]. STIs and BBPs require close contact for transmission [7]. They are diseases with a significant basis in behavioural patterns; their spread through a population occurs neither uniformly nor randomly [8]. Rather, it is often a function of complex, often intimate and/or taboo social interactions between two individuals or a network of people. Emphasis is placed on populations engaging in risk-based behaviours like unprotected sex, sex with many partners, and use of injected drugs through needle sharing [8,9]
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