Identification of Influential Nodal Persons among Injecting Drug Users:- A Social Network Analysis

Background: This study is concerned with Injecting Drug Users (IDUs) who couldn't able to followed up with the existing HIV prevention program due to the existence of stigma. These IDUs are living in Chennai city of South India which is cosmopolitan in nature and the bigger in size. Objective: The primary objective of this study is to identify the influential injecting drug user who plays an active role in carrying out different activities like buying and sharing of illicit drugs, seeking information and advising about HIV prevention using Social Network Analysis Methods: This quantitative cross-sectional study was conducted among IDUs undergoing Opioid Substitution Therapy (OST) during the study period April 2015- March 2016 were included in the study and they were 46 in number. As all the 46 IDUs were recruited as participants of this study, this network is considered as full network method, in which the existing relationship (Ties) among the IDUs was studied. The open source software Node XL was used to analyze the social network data. Centrality metrics of social network analysis like Degree, Closeness, Betweenness, Eigen Vector and Page Rank were used, to identify the influential IDUs (nodal persons) within networks of IDUs. Results: SNA had identified the UID-64 as one of the influential IDU (node) who is well known for his illicit drug dealings. He is well-connected with other IDUs members in the network this is because he communicates with the majority of the members for distributing illicit drugs and shares the same with them directly and also through other nodal persons. This analysis also identified UID-39 as a resource person who has provided HIV-related information to the maximum number of IDUs directly and indirectly and UID-67 had motivated a maximum number of IDUs in the network for HIV testing and to enroll with OST program. It is surprising to know that these three influential nodal persons were themselves had not enrolled with OST Program and were Ex users. Conclusion: Social network analysis of IDUs had identified the key nodal individuals who could be utilized for effectively imparting essential HIV prevention information and implementing behavioral communication. The study findings highlighted the possibilities of utilizing centrality metrics of the social network as a tool for effective follow-up of IDUs for HIV prevention. Key Words: OST- Opioid Substitution Therapy, IDU- Injecting Drug User, BCC- Behavior Change Communication, UID- Unique Identification, PE- Peer Educator and ORW- Out Reach Worker, NACO- National AIDS Control Organization, IBBS- Integrated Biological and Behavioural Surveillance, HSS-HIV Sentinel Surveillanc