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Sexual network position and risk of sexually transmitted infections
  1. C M Fichtenberg1,
  2. S Q Muth2,
  3. B Brown3,
  4. N S Padian4,
  5. T A Glass1,
  6. J M Ellen5
  1. 1
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2
    Quintus-ential Solutions, Colorado Springs, Colorado, USA
  3. 3
    Bixby Center for Global Reproductive Health Research & Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
  4. 4
    RTI International, San Francisco, California, USA
  5. 5
    Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr C M Fichtenberg, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, 6th Floor, Baltimore, MD 21205, USA; cfichten{at}


Objectives: A population-based sexual network study was used to identify sexual network structures associated with sexually transmitted infection (STI) risk, and to evaluate the degree to which the use of network-level data furthers the understanding of STI risk.

Methods: Participants (n = 655) were from the baseline and 12-month follow-up waves of a 2001–2 population-based longitudinal study of sexual networks among urban African–American adolescents. Sexual network position was characterised as the interaction between degree (number of partners) and two-reach centrality (number of partners’ partners), resulting in the following five positions: confirmed dyad, unconfirmed dyad, periphery of non-dyadic component, centre of star-like component and interior of non-star component. STI risk was measured as laboratory-confirmed infection with gonorrhoea and/or chlamydia.

Results: Results of logistic regression models with generalised estimating equations showed that being in the centre of a sexual network component increased the odds of infection at least sixfold compared with being in a confirmed dyad. Individuals on the periphery of non-dyadic components were nearly five times more likely to be infected than individuals in confirmed dyads, despite having only one partner. Measuring network position using only individual-based information led to twofold underestimates of the associations between STI risk and network position.

Conclusions: These results demonstrate the importance of measuring sexual network structure using network data to fully capture the probability of exposure to an infected partner.

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  • Funding This work was supported by grants from the National Institute for Allergy and Infectious Diseases and the National Institute on Drug Abuse.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by University of California, San Francisco Johns Hopkins Medical Institutions.

  • Patient consent Obtained.

  • Contributors: CMF designed and conducted the analyses and wrote the manuscript; BB led data collection in the field; SQM was responsible for network data management and assisted with network analysis; NSP helped design and oversee data collection; TAG advised on the analysis and interpretation, and helped draft the manuscript; JME conceived and conducted the Bayview Networks Study and helped design the analysis and draft the manuscript.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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