Multiplex Competition―Referral Networks of Social Venues and of Health Organizations for Young Men Who Have Sex with Men

This study explores a context of competition between social venues and between health organizations that are structured by different patterns of client referrals. Using the economic concept of properties of services/goods (“substitutes” or “complements”) and the network concept of structural equivalence, we derived several hypotheses regarding the associations between specific referral patterns and the presence of competition ties. Referral ties may exist among social venues and health organizations to better serve their clients, such that social venues may help clients to identify other venues that are more central to the gay community and that health organizations may help clients to obtain services that they themselves do not offer. Based on the data of 20 social venues and 20 health organizations in Chicago, IL, and Houston, TX, we tested our hypotheses using exponential random graph models. The results indicated a co-occurrence of referral and competition relationships between social venues. This tendency, however, was not found between health organizations. Health organizations in a similar network context in terms of referral inflow from other health organizations tended to have a competition relationship. The implications of these findings in terms of referral-competition networks between health organizations and between social venues are discussed.