Peer advocacy can promote HIV protective behaviors, but little is known about the concordance on prevention advocacy(PA) reports between people living with HIV(PLWH) and their social network members. We examined prevalence and correlates of such concordance, and its association with the targeted HIV protective behavior of the social network member. Data were analyzed from 193 PLWH(index participants) and their 599 social network members(alters). Kappa statistics measured concordance between index and alter reports of PA in the past 3 months. Logistic and multinomial regressions evaluated the relationship between advocacy concordance and alter condom use and HIV testing behavior and correlates of PA concordance. Advocacy concordance was observed in 0.3% of index-alter dyads for PrEP discussion, 9% for condom use, 18% for HIV testing, 26% for care engagement, and 49% for antiretroviral use discussions. Fewer indexes reported condom use(23.5% vs. 28.1%;[Formula: see text]=3.7, p=0.05) and HIV testing(30.5% vs. 50.5%; [Formula: see text]=25.3, p<0.001) PA occurring. Condom advocacy concordance was higher if the index and alter were romantic partners(OR=3.50; p=0.02), and lower if the index was 10 years younger than the alter(OR=0.23; p = 0.02). Alters had higher odds of using condoms with their main partner when both reported condom advocacy compared to dyads where neither reported advocacy(OR=3.90; p<0.001) and compared to dyads where only the index reported such advocacy(OR = 3.71; p=0.01). Age difference and relationship status impact advocacy agreement, and concordant perceptions of advocacy are linked to increased HIV protective behaviors. Alters\' perceptions may be crucial for behavior change, informing strategies for improving advocacy.

BACKGROUND: Innovative strategies are needed to disseminate HIV prevention messages across communities efficiently, as well as reduce HIV stigma while promoting HIV prevention. This randomized controlled trial will evaluate the efficacy of a social network-based group intervention, Game Changers, which trains persons living with HIV (PLWH) to encourage members of their social network to use HIV protective behaviors METHODS: PLWH in HIV care for at least 1 year will be randomly assigned to receive the 8-session group advocacy training intervention or no-intervention control group. Each enrolled PLWH (index participant) will be asked to recruit up to four social network members (alter participant). Assessments will be administered at baseline and months 6, 12, and 18 to both index and alter participants. The primary outcomes are HIV testing and condom use among alter participants; secondary outcomes are engagement in HIV prevention advocacy and internalized HIV stigma among index participants. Repeated-measures multivariable regression analyses will be conducted to compare outcomes between the intervention and control arms, in addition to a cost-effectiveness evaluation.
CONCLUSIONS: This social network-based approach to HIV prevention is particularly timely in the era of biomedical interventions, which require widespread penetration of effective HIV prevention and care messaging into communities. Positioning PLWH as central to the solution for controlling (vs. causing) the HIV epidemic has the potential to reduce HIV stigma and improve prevention outcomes at the individual and network levels.
BACKGROUND: ClinicalTrials.gov NIH Clinical Trial Registry NCT05098015. Registered on October 18, 2021.

Fifteen prevention-related publications in Eating Disorders during 2020 are reviewed. Two models frame this analysis: (1) the Mental Health Intervention Spectrum: health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into a cycle: rationale, theory, and methodology, shaped by critical, integrative reviews → clarification of risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination. In this cycle the first two phases and the last phase inform advocacy for social policies supporting prevention. Ten articles comprising a special issue on yoga demonstrate the value of investing in translational prevention science that acknowledges (a) embodying experiences as a broad category of protective factors; (b) the utility of multidimensional theoretical models; and (c) social justice issues that advocacy efforts must address to make programs widely and equitably available. Other articles reviewed show, for example, that studies of emotion dysregulation and emotional eating are needed to enter a prevention cycle that moves us beyond body image (or weight/shape) concerns in defining high-risk groups and developing indicated prevention. Finally, implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies are discussed.