Community Popular Opinion Leader Research Articles

Designing Evidence-Based Preventive Interventions That Reach More People, Faster, and with More Impact in Global Contexts.

This article demonstrates the substantial similarities globally among preventive, evidence-based interventions (EBIs) designed to address HIV by providing four examples: an HIV family-focused intervention, the Community Popular Opinion Leader intervention, a South African maternal/child health program, and an EBI for sex workers in India. Each identified the key problems in the target population, utilized well-established social cognitive theories, created processes for engaging the target population, set standards for staff accountability, and included routine data collection to facilitate iterative program improvements over time. Building EBIs based on these common, robust features is an alternative design strategy to replication with fidelity. These components provide a road map for researchers, especially those using new technologies, and for local providers seeking to deliver EBIs that match their clients' and communities' needs. Technology platforms and community organizations may serve as resources for designers of the next generation of EBIs, offering an alternative to repeatedly validating the same interventions and replicating them with fidelity.

Identifying HIV-related digital social influencers using an iterative deep learning approach.

Community popular opinion leaders have played a critical role in HIV prevention interventions. However, it is often difficult to identify these 'HIV influencers' who are qualified and willing to promote HIV campaigns, especially online, because social media influencers change frequently. We sought to use an iterative deep learning framework to automatically discover HIV-related online social influencers. Out of 1.15 million Twitter users' data from March 2018 to March 2020, we extracted tweets from 1099 Twitter users who had mentioned the keywords 'HIV' or 'AIDS'. Two Twitter users determined to be 'online HIV influencers' based on their conversation topics and engagement were hand-picked by domain experts and used as a seed training dataset. We modelled social influence and discovered new potential influencers based on these seeds using a graph neural network model. We tested the model's precision and recall compared with other baseline model approaches. We validated the results through manual verification. The model identified 23 new (manually verified) HIV-related influencers, including health and research organizations and local HIV advocates across the United States. Our proposed model achieved the highest accuracy/recall, with an average improvement of 38.5% over the other baseline models. Results suggest that iterative deep learning models can be used to automatically identify new and changing key HIV-related influencers online. We discuss the implications and potential of HIV researchers/departments applying this approach across online big data (e.g. hundreds of millions of social media posts per day) to help promote HIV prevention campaigns to affected communities.

Individual and Social Network Factors Associated with High Self-efficacy of Communicating about Men's Health Issues with Peers among Black MSM in an Urban Setting.

Black men who have sex with men (BMSM) bear a disproportionate burden of HIV in the USA. BMSM face stigma, discrimination and barriers to health care access, and utilization. Peers (male or female) may assist BMSM in navigating their health issues by engaging in communication to support in their health care needs. Individuals with high self-efficacy of communicating about men's health issues with peers can be trained as community popular opinion leaders (CPOLs) to change peer behaviors by promoting risk reduction communication. We examined the characteristics associated with high self-efficacy of communicating with peers about men's health issues among 256 BMSM from a behavioral HIV intervention conducted in Baltimore, Maryland. In the multivariate logistic model, gay identity (AOR: 2.10, 95% CI: 1.15,3.83), involvement in the house and ballroom community (AOR: 2.50, 95% CI: 1.14,5.49), larger number of network members who are living with HIV (AOR: 6.34, 95% CI: 1.48,27.11), and larger number of network members who would loan them money (AOR: 1.46, 95% CI: 1.05,2.03) were statistically significantly associated with high self-efficacy of communicating with peers about men's health issues. We also found that having depressive symptoms (AOR: 0.43, 95% CI: 0.24, 0.77) was negatively associated with high self-efficacy of communicating with peers about men's health issues. Findings from the current study can inform future studies to identify better CPOLs who are able to communicate effectively with peers about men's health issues for BMSM.

Estimating self-reported sex practices, drug use, depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods

ABSTRACTMen who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.

Validity of the CAGE questionnaire for men who have sex with men (MSM) in China

BackgroundDetection of heavy drinking among men who have sex with men (MSM) is crucial for both intervention and treatment. The CAGE questionnaire is a popular screening instrument for alcohol use problems. However, the validity of CAGE for Chinese MSM is unknown. MethodData were from three waves of cross-sectional assessments among general MSM (n=523) and men who sell sex to other men (“money boys” or MBs, n=486) in Shanghai, China. Specifically, participants were recruited using respondent-driven, community popular opinion leader, and venue-based sampling methods. The validity of the CAGE was examined for different cutoff scores and individual CAGE items using self-reported heavy drinking (≥14 drinks in the past week) as a criterion. ResultsIn the full sample, 75 (7.4%) of participants were classified as heavy drinkers. 32 (6.1%) of general MSM and 43 (8.9%) of MBs were heavy drinkers. The area under curve statistics for overall sample was 0.7 (95% CI: 0.36–0.77). Overall, the sensitivities (ranging from 18.7 to 66.7%), specificities (ranging from 67.5 to 95.8%), and positive predictive values (ranging from 14.1 to 26.4%) for different cutoff scores were inadequate using past week heavy drinking as the criterion. The ability of CAGE to discriminate heavy drinkers from non-heavy drinkers was limited. ConclusionsOur findings showed the inadequate validity of CAGE as a screening instrument for current heavy drinking in Chinese MSM. Further research using a combination of validity criteria is needed to determine the applicability of CAGE for this population.

Impact of a community popular opinion leader intervention among African American adults in a southeastern United States community.

We examine the impact of an adapted community popular opinion leader (C-POL) intervention targeting alcohol-using social networks in Southeast Louisiana. A pre-post C-POL was conducted between October 2009 and April 2013, targeting alcohol users. A total of 65 popular opinion leaders were recruited, trained, and deployed into their social networks to diffuse intervention messages. Anonymous community surveys conducted within the venues among 99 male and female participants at baseline and 197 at 6 months to 1 year later revealed significant behavioral and knowledge changes. Average sexual risk score based on 7 sexual risk items declined from 15.3 to 11.9 (p<0.001); the number of vaginal and anal sex partners in the last year decreased from 11.3 to 7.7 and 3.9 to 2.3, respectively (p<0.01); and HIV knowledge score (based on % correct) increased from 67.2 to 76.8% (p<0.001). Findings add to the evidence base surrounding peer interventions.

Drug Use and Sexual Behaviors Among MSM in China

Background: This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka “money boys”) in China. Objectives: Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. Methods: The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. Results: MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. Conclusions: It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.

Reducing STD/HIV stigmatizing attitudes through community popular opinion leaders in Chinese markets.

Reducing STDs and HIV/AIDS incidence requires campaigns designed to change knowledge, attitudes and practices of risky sexual behavior and its consequences. In China, a significant obstacle to such changes is the stigma associated with these diseases. Thus one campaign intervention strategy is to train credible community popular opinion leaders to discuss these issues in everyday social venues. This study tested the effectiveness of such an approach on reducing HIV/AIDS stigma, across two years, from a sample of over 4500 market vendors, in three conditions. Results showed an increasing growth in market communication about intervention messages, and concomitant declines in stigmatizing attitudes, across time, with the greatest changes in community popular opinion leaders, significant changes in intervention non-opinion leaders, and little change in the control markets.

Alcohol use and abuse among rural Zimbabwean adults: A test of a community-level intervention

BackgroundUnderstanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a Community Popular Opinion Leader (CPOL) community-based intervention partly directed at reducing alcohol abuse. MethodsTests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18–30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects. ResultsHigher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels. ConclusionsAlthough no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

Harnessing Online Peer Education (HOPE): Integrating C-POL and social media to train peer leaders in HIV prevention

Novel methods, such as Internet-based interventions, are needed to combat the spread of HIV. While past initiatives have used the Internet to promote HIV prevention, the growing popularity, decreasing digital divide, and multi-functionality of social networking sites, such as Facebook, make this an ideal time to develop innovative ways to use online social networking sites to scale HIV prevention interventions among high-risk groups. The UCLA Harnessing Online Peer Education study is a longitudinal experimental study to evaluate the feasibility, acceptability, and preliminary effectiveness of using social media for peer-led HIV prevention, specifically among African American and Latino Men who have Sex with Men (MSM). No curriculum currently exists to train peer leaders in delivering culturally aware HIV prevention messages using social media. Training was created that adapted the Community Popular Opinion Leader (C-POL) model, for use on social networking sites. Peer leaders are recruited who represent the target population and have experience with both social media and community outreach. The curriculum contains the following elements: discussion and role playing exercises to integrate basic knowledge of HIV/AIDS, awareness of sociocultural HIV/AIDS issues in the age of technology, and communication methods for training peer leaders in effective, interactive social media-based HIV prevention. Ethical issues related to Facebook and health interventions are integrated throughout the sessions. Training outcomes have been developed for long-term assessment of retention and efficacy. This is the first C-POL curriculum that has been adapted for use on social networking websites. Although this curriculum has been used to target African-American and Latino MSM, it has been created to allow generalization to other high-risk groups.

Impact of international laboratory partnerships on the performance of HIV/sexually transmitted infection testing in five resource-constrained countries.

To review a quality control and quality assurance (QC/QA) model established to ensure the validity and reliability of collection, storage and analysis of biological outcome data, and to promote good laboratory practices (GLPs) and sustained operational improvements in international clinical laboratories, we conducted a two-arm randomized community-level HIV behavioural intervention trial in five countries: China, India, Peru, Russia and Zimbabwe. The trial was based on diffusion theory utilizing a Community Popular Opinion Leaders (CPOLs) intervention model with behavioural and biological outcomes. The QC/QA model was established by the Biological Outcome Workgroup, which collaborated with the Data Coordinating Center and John Hopkins University Reference Laboratory. Five international laboratories conducted chlamydia/gonorrhoea polymerase chain reaction (PRC)-based assays, herpes simplex virus type 2 enzyme immunoassay (EIA), syphilis serology (rapid plasma regain and Treponema pallidum particle agglutination assay, HIV serology (EIA/Western blot) and Trichomonas vaginalis culture. Data were collected at baseline, 12 and 24 months. Laboratory performance and infrastructure improved throughout the trial. Recommendations for improvement were consistently followed. Quality laboratories in resource-poor settings can be established, operating standards can be improved and certification can be obtained with consistent training, monitoring and technical support. Building collaborative partnership relations can establish a sustainable network for clinical trials, and can lead to accreditation and international laboratory development.

Attitudinal, Behavioral, and Biological Outcomes of a Community Popular Opinion Leader Intervention in China

The effects of a community popular opinion leader (CPOL) intervention were examined among market vendors in a city on the eastern coast of China. Employees of 40 food markets were enrolled in a study that provided HIV-related education and tests, and treatment for sexually transmitted diseases (STDs). Twenty markets were randomly assigned to a CPOL intervention (N = 1,695) and 20 markets to a control condition (N = 1,616). Market employees in the intervention condition reported positive attitudes regarding STD/HIV prevention and more frequent discussions about safe sex than those in the control condition. Compared with baseline, the prevalence of unprotected sexual acts and new STDs were significantly lower within each study condition 24 months later. Although the CPOL intervention achieved its goal of shifting attitudes within food markets, the gains did not lead to the expected behavioral and biological outcomes.

Abstract A17: Prostate cancer screening of African American men aged 40–75 in Jefferson County, Arkansas

Abstract Prostate Cancer Screening of Men in Jefferson County, Arkansas applicably named Men Aware of Cancer (MAC) is an interdisciplinary pilot study that aims to utilize a Community Popular Opinion Leaders model (CPOL) by recruiting ten community leaders, who will recruit one-hundred (100) men of Black/African American) descent, aged 40–75, in Jefferson County, Arkansas, for a prostate cancer prevention awareness and action program. The MAC pilot program seeks to educate the community about co-morbidities and other health related issues such as obesity, dietary intake, and physical inactivity behaviors that play a role in the onset and development of prostate cancers. Ten CPOLs will be recruited through local churches, barbershops, civic organizations, and physician's offices, and trained to assist in reaching and mentoring the target population in Jefferson County, Arkansas. CPOLs will assist in the discussion and dissemination of literature, identification of patient barriers to active individual prevention and screening, and recruit participants for the educational components of the program that will be provided throughout the year. The MAC pilot program will also provide community based, accessible, and culturally relevant programming, that will bridge the gap between community members and health care. The overall goal is to affect the disproportionate cancer health disparities experienced in Black/African American communities in Jefferson County and throughout Arkansas. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A17.

P1-S6.45 Impact of a community level, diffusion based HIV/STI intervention on heterosexually-identified, socially marginalised men in urban, coastal Peru

ObjectivesThe NIMH Collaborative HIV/STD Intervention Trial implemented a 2-year intervention based on the theory of diffusion of innovations to decrease unprotected sex with non-primary partners among high-risk populations including heterosexually-identified,...

Alternative Explanations for Negative Findings in the Community Popular Opinion Leader Multisite Trial and Recommendations for Improvements of Health Interventions Through Social Network Analysis

To the Editors:We read with great interest the report of the Results of the National Institute of Mental Health Collaborative HIV/Sexually Transmitted Disease Prevention Trial of a Community Popular Opinion Leader (C-POL) Intervention.1 This trial tested whether a well-described and effective commun

Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial

ObjectivesA community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out...

Effect of a Community Popular Opinion Leader HIV/STI Intervention on Stigma in Urban, Coastal Peru

Evaluating interventions that reduce HIV stigma may help to craft effective stigma-reduction programs. This study evaluates the effects of a community popular opinion leader HIV/STI intervention on stigma in urban, coastal Peru. Mixed effects modeling was used to analyze data on 3,049 participants from the Peru site of the NIHM collaborative trial. Analyses looked at differences between the comparison and intervention groups on a stigma index from baseline to 12- and 24-month follow-up. Sub-analyses were conducted on heterosexual-identified men (esquineros), homosexual-identified men (homosexuales), and socially marginalized women (movidas). Compared to participants in the comparison group, intervention participants reported lower levels of stigma at 12- and 24-month follow-up. Similar results were found within esquineros and homosexuales. No significant differences were found within movidas. Findings suggest that interventions designed to normalize HIV prevention behaviors and HIV communication can reduce HIV-related stigma and change community norms.

Results of the NIMH collaborative HIV/sexually transmitted disease prevention trial of a community popular opinion leader intervention.

To determine whether community populations in community popular opinion leader intervention venues showed greater reductions in sexual risk practices and lower HIV/sexually transmitted disease (STD) incidence than those in comparison venues. A 5-country group-randomized trial, conducted from 2002 to 2007, enrolled cohorts from 20 to 40 venues in each country. Venues, matched within country on sexual risk and other factors, were randomly assigned within matched pairs to the community popular opinion leader intervention or an AIDS education comparison. All participants had access to condoms and were assessed with repeated in-depth sexual behavior interviews, STD/HIV testing and treatment, and HIV/STD risk-reduction counseling. Sexual behavior change and HIV/STD incidence were measured over 2 years. Both intervention and comparison conditions showed declines of approximately 33% in risk behavior prevalence and had comparable diseases incidence within and across countries. The community-level intervention did not produce greater behavioral risk and disease incidence reduction than the comparison condition, perhaps due to the intensive prevention services received by all participants during the assessment. Repeated detailed self-review of risk behavior practices coupled with HIV/STD testing, treatment, HIV risk-reduction counseling, and condom access can themselves substantially change behavior and disease acquisition.

HIV risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants

To examine HIV/AIDS-related knowledge, attitudes and behaviours among 'money boys' and general male migrants in Shanghai, China. A quantitative cross-sectional design with self-administered paper-and-pencil instruments was used. A total of 239 money boys were enrolled using community popular opinion leader and respondent-driven sampling methods, and 100 general male migrants were enrolled through venue-based sampling. Compared to general male migrants, money boys were significantly younger, better educated, more likely to be single, earned a higher income, suffered greater stress, and were less satisfied with life in Shanghai. Both groups had substantial misconceptions about HIV/AIDS, although general male migrants were less well informed. Furthermore, both groups reported low rates of condom use, regardless of who their sexual partners were. Money boys were more likely to use alcohol, had more sexual partners and more casual sex partners, and were more likely to engage in other sexual risks. Moreover, they were likely to be the victims of sexual violence at the hands of their clients. More than half of the money boys had been tested for HIV and 3% self-reported to be HIV-positive, whereas only 1% of the general male migrants had ever been tested and all self-reported to be HIV-negative. Infection with other sexually transmitted diseases was also reported by money boys. This study suggests an urgent need to implement HIV/AIDS prevention and intervention programs targeting male migrants, especially money boys and their clients. Some recommendations for conducting interventions among the male migrant population in China are suggested.

The community popular opinion leader HIV prevention programme: conceptual basis and intervention procedures.

To describe the community popular opinion leader (C-POL) intervention employed in the NIMH Collaborative HIV/STD Prevention Trial, including its theoretical, conceptual, and empirical basis, intervention procedures and methods, core elements, and how its content was culturally tailored to address the needs of varied populations. The programme is designed to identify, recruit, train, and intensively engage C-POLs of a target population to convey HIV risk reduction messages to people in their communities, with the intention of reducing high-risk behavior at a population level. Based on the diffusion of innovation theory, the intervention identified, trained, and engaged C-POL within a high-risk community population to advocate, recommend, and endorse the importance of safer behavior to other members of the same population. Nine core elements of the intervention are discussed. Data collected during rapid ethnography were used to adapt the content of the intervention for food market owners and workers in China, male patrons of wine shops and at-risk women congregating nearby in India, young people in social gathering venues in Peruvian barrios, dormitory students in Russia, and people congregating in commercial areas of growth points in Zimbabwe. The C-POL intervention model taps into community strengths, altruism, and people's desire to do something to help fight against AIDS. With few exceptions, C-POLs participated enthusiastically in the training sessions and reported having conversations in the community. Rapid ethnography can be used to tailor an intervention to diverse settings while maintaining fidelity to the core elements of the intervention.