Introduction
The theory of social capital argues that social connections and networks are valuable to members of groups who may derive resources from within their networks [
1‐
4]. The two dominant perspectives of social capital, the network approach and social cohesion approach [
3], are distinct in several ways. Network approaches employ social network analyses and typically measure resources proffered from network membership [
5‐
8], whereas a social cohesion approach measures social capital as trust, reciprocity, civic engagement, and social participation [
9‐
12]. Similarities in the two dominant perspectives include their embeddedness within an ecological framework, whereby an individual’s health and behavior are influenced from factors at multiple levels. Despite differences in measurement, both social capital perspectives define social capital as the resources afforded by social connections and the potential for an individual to gain access to those resources. Few studies have integrated network measures with social cohesion to measure social capital [
1,
12].
Higher social capital may be protective for multiple health outcomes, including HIV infection [
13,
14]. Sexual minority men and gender minority individuals, including gay, bisexual, and other men who have sex with men (GBMSM) and transgender people of color, experience the highest rates of new HIV diagnoses among all groups. An estimated one in two Black GBMSM and one in four Latino GBMSM will acquire HIV in their lifetime [
15] and one in six GBMSM living with HIV is unaware of their status [
16]. The HIV burden among trans women is startling: the estimated prevalence of HIV is 34 times that of cisgender adults [
17,
18], and incident infections among trans women remain high [
19]. Among US adults, less than 0.5% are living with HIV infection. However, a recent metanalysis reported that overall HIV prevalence among transgender individuals is 9.2%, and the prevalence among trans women is even higher (14.1%). HIV prevalence among trans men is approximately 3.2% [
20]. Trans people of color are disproportionately affected by HIV: 44% of trans individuals diagnosed are Black and 26% are Hispanic/Latinx [
18].
Recent US studies have explored social capital and HIV outcomes. In Los Angeles, a study found that HIV transmission risk behaviors and HIV testing were associated with higher social capital resources [
21]. Ransome et al. [
22] found that higher social capital was associated with lower odds of concurrent sexual partnerships among African American women compared to men. Men with higher social capital were more likely to engage in concurrent sexual relationship. Another study found that social capital moderated the relationship between sex-work-related stigma and condomless sex acts with non-paying partners. The association was significant among male sex workers with lower social capital, but not among men with higher social capital [
23]. Another study found that loss of social capital within family and social relationships motivated GBMSM to not disclose their sexual orientations or identities [
24]. Measures of social capital have also been associated with HIV medication adherence among people living with HIV [
25]; late HIV diagnoses [
26,
27], and STI diagnoses [
28]. International studies have employed several different measures of social capital and found associations with higher rates of HIV testing among GBMSM [
29], reduced risk behaviors and participation in HIV-related meetings among female sex workers [
30], and reduced HIV risk behaviors and a decline in HIV incidence [
31,
32].
Zarwell and Robinson established a preliminary instrument, the
Constructed Family Social Capital Scale, that blends social cohesion and network indicators to measure social capital among GBMSM who belonged to constructed families [
33]. They argued that social capital is a collective construct created through participation in social organizations, such as constructed families, which may be characterized by network indicators
. Constructed families are important social networks within the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) community and include gay families, pageant families, and the house ball community [
34‐
38]. Constructed families are an important source of social support within the LGBTQ community and membership within constructed families has been associated with lower risk behaviors among GBMSM of color. The social embeddedness of constructed family members supports both of the dominant perspectives of social capital. Constructed families offer peer support to sexual minority men and gender minority individuals who may experience intersectional stigmas related to their racial and gender identities or sexual orientation, which may promote health behaviors including HIV testing, medication to prevent HIV infection, and treatment for people living with HIV [
38‐
41].
In this exploratory study, we assess the previously evaluated Constructed Family Social Capital Scale to create a new tool to measure social capital within social networks of sexual minority men and gender minority individuals.
Results
In total, 298 participants were cisgender men (77.8%), 35 were trans men (9.1%), 27 individuals identified as non-binary or another identity (7.0%), and 23 participants were trans women (6.0%). The majority of the sample were White (
n = 235; 61.5%), followed by Black (
n = 97; 25.1%), or more than one or another race (
n = 51; 13.1%). Only 42 participants (11.3%) were Hispanic/Latinx. Sixty-nine (17.9%) participants identified as bisexual, 266 (68.9%) identified as gay, 19 (4.9%) identified as pansexual, 15 (3.9%) identified as straight, and 17 (4.4%) reported another sexual identity. None of the cisgender men identified as straight. In total, 228 (59.5%) participants worked full-time, whereas 91 (23.6%) reported working part-time and 64 (16.7%) were unemployed. Participant ages ranged from 18 to 97, with a mean age of 31.75 years (
SD = 13.38). Participants reported moderate material hardship on average, with a mean score of 2.52 (
SD = 1.36). On average, participants reported a social network size of 17.13 people (
SD = 40.91, Range: 0–500).
Table 1
Demographic Characteristics (N = 383)
Gender Identity |
Man | 298 | 77.8 |
Trans man | 35 | 9.1 |
Trans woman | 23 | 6.0 |
Non-binary or another identity | 27 | 7.0 |
Race |
Black | 97 | 25.1 |
White | 235 | 61.5 |
More than one race or Another race | 51 | 13.1 |
Ethnicity |
Hispanic / Latinx | 42 | 11.3 |
Sexual Orientation |
Bisexual | 69 | 18.0 |
Gay | 266 | 69.2 |
Pansexual | 19 | 5.0 |
Straight | 12 | 3.13 |
Other | 17 | 4.4 |
Work Status | | |
Full-time | 228 | 59.5 |
Part-time | 91 | 23.8 |
Unemployed | 64 | 16.7 |
Factor analyses
EFA results suggested meaningful factor structure among
Network Social Capital Scale items (KMO = .85; Bartlett’s Test
χ2 [
35] = 839.62,
p < .001). The scree plot suggests a maximum of two factors, and eigenvalue cut-offs for factor 1 (eigenvalue = 4.34, 48.24% variance explained) and factor 2 (eigenvalue = 1.20, 13.33% variance explained) supports this maximum of two factors. Using a factor loading cut-off of .30, all items cross-load on both factors. Such high degrees of cross-loading support the retention of only one factor [
52], in this instance comprising a total social capital score. Internal consistency for this total score was acceptable (α = .86). Factor loadings are listed in Table
2.
The
Network Social Capital Scale demonstrated acceptable fit to the data, χ
2 (21) = 44.93,
p = .006, CFI = .97, SRMR = .04, TLI = .96, RMSEA = .07 (90% CI = .04, .10). This included three pairs of theoretically-supported correlated error terms (1 and 2; 4 and 6; 8 and 9). All items demonstrated expected significant positive loadings on the social capital latent variable (see Table
2, all
ps < .001). The original six items in the
Constructed Family Social Capital Scale demonstrated acceptable fit to the data, χ
2 (13) = 22.24,
p = .004, CFI = .97, SRMR = .04, TLI = .94, RMSEA = .10 (90% CI = .05, .15). This included one pair of correlated theoretically-supported error terms (1 and 2), as suggested by modification indices. All items demonstrated expected significant positive loadings on the social capital latent variable (see Table
2, all
ps < .001). Internal consistency was acceptable both for the total score using all nine items (α = .88) and the shortened set of six items modified from the
Constructed Family Social Capital Scale (α = .83). We found no statistically significant differences in social capital scores based on demographic characteristics.
Table 2
Factor Analysis Item Loadings for Network Social Capital Scale
1. (Social Influence) Have influenced important decisions in the past 3 months? | 0.38 | .32 | .52 | .46 | .45 |
2. (Multiplexity) Fulfill multiple roles in your life (i.e. a friend but also a classmate, co-worker, etc.)? | 0.41 | .32 | .55 | .40 | .42 |
3. (Heterogeneity) Are similar to you (in terms of gender, race, sexuality, etc.)? | 0.53 | .39 | .36 | .59 | – |
4. (Trust) Do you trust in general? | 0.63 | .52 | .77 | .67 | .68 |
5. (Quality of Support) Can you go to for advice or borrow money or something valuable if you need it? | 0.48 | .58 | .76 | .72 | .72 |
6. (Social Cohesion) Would not take advantage of you if they got the chance? | 0.60 | .42 | .66 | .57 | – |
7. (Compositional Quality) Could you ask for advice or help about your health? | 0.59 | .83 | .66 | .89 | .89 |
8. (Compositional Quality) Could you ask for advice or help about HIV or other STDs? | 0.51 | .95 | .58 | .82 | .82 |
9. (Compositional Quality) Could you ask for advice or help about LGBTQ-related healthcare? | 0.49 | .86 | .50 | .78 | – |
Discussion
We tested a modified social capital scale originally developed for use within constructed families of GBMSM within a wider population of sexual minority men and gender minority individuals. The original six items from the Constructed Family Social Capital Scale performed well within our population of sexual minority men and gender minority individuals when asked in reference to social network members (α = .84). Moreover, the reliability for all nine of the modified items in our Network Social Capital Scale had high internal consistency (α = .87). Our exploratory and confirmatory factor analyses support the use of our Network Social Capital Scale items to measure social capital within social networks of sexual minority men and gender minority individuals. Whereas the original scale study participants were recruited from venues in New Orleans and items specifically asked questions about members of constructed families, we modified the questionnaire to ask about members of participants’ social support networks more broadly. Thus, our findings indicate that the original items asked in the Constructed Family Social Capital Scale function well in different settings and with different populations.
Researchers have long argued that harnessing networks may improve effective health promotion programs, particularly to reduce the spread of sexually transmitted infections such as HIV [
56]. Recent approaches to address HIV disparities include increasing the uptake of pre-exposure prophylaxis (PrEP), a daily pill that effectively prevents sexual transmission of HIV, among sexual and gender minority individuals at elevated risk for HIV infection [
57]. Studies have also found associations with social capital and awareness and willingness to take PrEP. For example, social capital measured as community group participation has been associated with awareness of and willingness to take PrEP among GBMSM [
58,
59]. One study exploring resilience, resources, and networks concluded that family-based social capital or social support interventions may improve PrEP uptake among young Black GBMSM and trans women [
60]. Together, these findings indicate the need for interventions to increase social capital among underserved populations at elevated risk for HIV infection, which may impact the HIV-prevention continuum, particularly the uptake of PrEP to prevent HIV infection [
61,
62].
Our findings further our ability to measure social capital within social networks of sexual minority men and gender minority individuals to improve health promotion programming. The resources afforded to sexual minority men and gender minority individuals within their social networks may influence HIV [
14] or other health outcomes, and this scale may be useful for future studies to explore the influence of social capital on HIV prevention and treatment interventions that leverage online networks such as Empowering with PrEP (E-PrEP) [
63]. Given that social networks often share similar risk behaviors [
64] and may vary by race or gender [
65,
66], social network tools may be critical to rapidly identify HIV cases as they continue to disproportionately affect GBMSM and transgender women. Previous studies indicate that disparities in HIV within these disproportionately affected groups may be attributed to higher underlying prevalence of HIV within their networks [
67], rather than greater risk behavior [
41,
68‐
72], indicative of the need for social network interventions that harness networks for HIV prevention efforts [
73]. A recent publication titled “A new era of HIV risk: It’s not what you know, it’s who you know (and how infectious)” suggests that future approaches to end HIV must take into account social, sexual, and drug use network connections [
74]. Because network characteristics, including the degree of similarity (i.e.
homophily), norms, and beliefs are important facilitators to HIV acquisition, future studies may adapt or use this scale to measure social capital within social, sexual, or drug using networks. In addition, researchers may utilize or modify this tool to measure and evaluate the efficacy of interventions designed to enhance social capital among sexual minority men and gender minority individuals.
Limitations
Our cross-sectional study provides a snapshot of social capital measured among a population of patrons at a Pride festival event in Milwaukee in 2018, and therefore is not representative of all sexual minority men and gender minority individuals. It is possible that individuals with higher social capital and more community connectedness may attend Pride events. We assessed a previously developed preliminary instrument, which we modified to be more inclusive by adding an additional item about the number of social network members participants could talk to about LGBTQ health-related information. These limitations notwithstanding, our results provide a brief and reliable measure to assess social capital among sexual minority men and gender minority individuals. Our findings support wider use of this scale in larger samples using different recruitment methods, as venue or event-based recruitment may bias the applicability of this scale to individuals who are not reached by these methods.
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