A Sicangu-driven social network strategy for syphilis prevention

About This Grant

Abstract This developmental research grant award (R21) requests funds to characterize the social and transmission networks of Rosebud Sioux Tribe (RST) (Sicangu Lakota Oyate) community members to mitigate ongoing and future syphilis epidemics among American Indian/Alaska Native (AI/AN) populations and move towards elimination of congenital syphilis: A Sicangu-driven social network strategy for syphilis prevention (S4). In addition to classic transmission networks, we include social networks that confer influence, social support, diffuse information/innovation and can lead to syphilis prevention interventions that the team has experience implementing. AI/AN individuals in South Dakota (SD) are one of the most syphilis impacted communities and are at increased risk of syphilis transmission, including congenital syphilis. In 2020, 3% of all AI/AN babies born in South Dakota had congenital syphilis. AI/AN individuals are more likely to live in rural areas with limited access to prenatal care and hospital obstetric units, creating barriers to timely identification and treatment of syphilis. Earlier this year, The Great Plains Tribes requested emergency assistance from the federal government to declare a public health emergency and address the syphilis epidemic. Critical to public health is improving syphilis prevention among AI/AN communities and their larger social networks. Network analysis traditionally focuses on transmission dynamics and potential for future epidemics. Contact tracing and other strategies do not, however, fully include the larger social network and data can be limited due to the stigma associated with providing names, as well as mistrust in government and healthcare providers, particularly for AI/AN individuals. Social network analysis that this team has expertise in, can illuminate multiple networks and develop metrics tied not only to disease transmission but to diffusion of information, and among highly marginalized groups such as people who use substances. The PI has a track record of collaborative work implementing participant network recruitment protocols such as the Social Network Strategy to be used in S4. The PI and site-PI are joined by additional experts in AI/AN Health, Indigenous community leaders and local community members engaging in Talking Circles in these contexts. Accordingly, we aim to: Characterize the social networks of RST community members and measure features of their network structure— assortativity, density and bridging – most relevant to syphilis transmission and network intervention; Explore individual (ie. age, education), contextual (ie employment type), network and structural (stigma, health care access) factors associated with syphilis seropositivity. We will collect survey data and biologic samples to model potential factors associated with historic and recent syphilis transmission and; Determine individual and social network level factors associated with syphilis prevention behaviors (ie. condom use, drug treatment, doxyPEP) and network intervention (ie. information sharing, proportion approving of syphilis prevention), which could lead to future network interventions.