A recent qualitative study conducted by Carol Golin, Eunice Okumu, members of the CFAR’s Social, Behavioral, and Implementation Sciences (SBIS) Core, as well as Ann Dennis, the co-leader of the UNC CFAR Scientific Working Group explored key challenges and opportunities in implementing an enhanced Social Network Strategy (eSNS) to expand HIV prevention and care access among Black sexual and gender minority (BSGM) populations in the U.S. South—a group disproportionately impacted by HIV. The study was conducted in an Ending the HIV Epidemic (EHE) priority jurisdiction and included interviews and focus groups with HIV service providers, health department officials, and community-based organization leaders. Using the Consolidated Framework for Implementation Research (CFIR), researchers identified three central “Peer Paradoxes” related to trust within social networks:
- The Incentives Paradox: Financial incentives can strengthen peer engagement but may also risk making interactions feel transactional.
- The Readiness Paradox: Individuals best positioned to reach peers often need the most support to effectively deliver the intervention.
- The Credibility Paradox: While peers may be trusted personally, they may not be viewed as reliable sources of HIV-related information.
These findings highlight the delicate balance between trust and mistrust that can influence the effectiveness of peer-led HIV interventions. To increase the acceptability and success of SNS-based models like eSNS, the study recommends that practitioners address peer credibility, readiness, and the nuanced role of incentives throughout implementation.
Key Contributions:
- Provides practical guidance for adapting SNS approaches to the realities of BSGM communities.
- Emphasizes the importance of context, trust, and equity in implementation.
- Informs strategies for integrating social network-based HIV prevention into public health and CBO settings.
- This work reinforces the critical need for tailored, community-informed strategies as we work toward ending the HIV epidemic—especially in high-priority regions like the U.S. South. To read the full article, click here.