Get Off the Sexual Network

When I was in Uganda last month, I was talking with collaborators, field assistants, villagers, taxi drivers, bartenders – pretty much anyone who would listen – about social networks, I was struck by what a sophisticated understanding of social networks my average interlocutor had.  As part of our project examining the risk of zoonotic disease spillover in rural Uganda, we are gathering data on individual people’s personal networks. We are interested in contact networks, for sure, but we are also examining people’s social capital – the resources to which an individual has access for instrumental action that are embedded in his or her social network. There are generally two classes of definitions of social capital used in the literature. The first, made famous by Robert Putnam‘s book, Bowling Alone, is really a measure of community solidarity. How cohesive are communities and how does this contribute to individuals’ and communities’ welfare?  The definition I typically employ is attributable to Bourdieau and a host of other scholars, especially Nan Lin. This definition emphasizes both the networked nature of social capital and the instrumentality of it.

The reasoning behind doing a social capital inventory in conjunction with our study of zoonotic disease spillover risk is to have a thorough description of the “state” of individuals. Social surveys typically measure income, household wealth, land holdings, etc. One measures such things in a social survey because one is interested in the economic state of the individual or household in which she is embedded. Social capital is a measure of economic – and social – well-being for people where many of the resources that they need to succeed, or even just get by, are not specifically located in the household or with the individual. We suspect that people in rural Uganda will vary in the amount of social capital they have and that this may be a major axess of vulnerability.

So, there I am, talking to anyone who would listen about the best way to gather information on personal social networks and it turns out that everyone I spoke with was amazingly familiar with the whole concept of social networks. The catch is, the networks with which they are familiar are a special type of networks – sexual networks. When I asked how everyone seemed to know so much about sexual networks, they pointed me to a public-service advertising campaign for which the tag line is “get off the sexual network.” Despite the Central African origin of HIV-1, Uganda was an early center for the epidemic. However, as noted by Stoneburner and Lowbeer, in their important 2004 paper, Uganda experienced substantial – and early – decline in HIV-1 incidence because of health communication through social networks. They write:

The response in Uganda appears to be distinctively associated with communication about acquired immunodeficiency syndrome (AIDS) through social networks. Despite substantial condom use and promotion of biomedical approaches, other African countries have shown neither similar behavioral responses nor HIV prevalence declines of the same scale. The Ugandan success is equivalent to a vaccine of 80% effectiveness. (Stoneburner & Lowbeer 2004)

I definitely need to check out the current state of the art to see if other countries in Sub-Saharan Africa have now experienced similar public health gains as a result of network-oriented interventions.

Based on my rather unsystematic sample, I’d say that this campaign has really worked raise people’s understanding of relational interconnectedness.  I was not able to get a picture of the huge billboards on the Kampala-Entebbe Highway (because it was always dark when I drove by them) but the TV ad is available on youtube. On the one hand, this is really great (both for the obvious public health reasons and because people seem to have a good understanding of webs of social relations). On the other hand, it will probably mean we will need to work hard to clarify what types of networks we mean when we gather our network data.

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