Social support and HIV

Benefits and challenges of a community-based programme for women living with HIV in Mali

Gundo-So is a community-based programme developed by and for women living with HIV (WLHIV) in Mali through the ARCAD-Santé-PLUS association. It provides support, co-constructed with WLHIV, to develop strategies on whether or not to disclose their status. The aim of the ANRS-12373 research is to evaluate the impact of this programme in the short and medium term. As part of this research, semi-structured interviews were conducted with participants (14). These interviews were analysed thematically. Three themes are presented here: positive feedback from the programme, which enabled them to be listened to and supported them both psychologically and financially. The impact of the programme on the participants' social network is also described, in terms of the links made with peers met during the programme. Finally, a new perspective on issues such as disease management, which improved through the contribution of knowledge, and also through the development of psychosocial resources. The programme enabled participants to acquire psychosocial skills, the ability to effectively self-manage their condition, and strategies on whether or not to disclose their HIV status. Participants' empowerment and social support in relation to the disease were developed through the programme, particularly through the links created with other women living with HIV.

Mindfulness-based stress reduction for HIV-associated neurocognitive disorder: Rationale and protocol for a randomized controlled trial in older adults

The symptom burden of HIV-associated neurocognitive disorder (HAND) is high among older individuals, and treatment options are limited. Mindfulness-based stress reduction (MBSR) has potential to improve neurocognitive performance, psychosocial wellbeing, and quality of life, but empirical studies in this growing vulnerable population are lacking. In this trial, participants (N = 180) age 55 and older who are living with HIV infection, are on combination antiretroviral therapy with suppressed viral loads, and yet continue to experience behavioral and cognitive symptoms of HAND, are randomized to MBSR or to a waitlist control arm that receives MBSR following a 16-week period of standard care. Primary outcomes (attention, executive function, stress, anxiety, depression, everyday functioning, quality of life) and potential mediators (affect, mindfulness) and moderators (social support, loneliness) are assessed at baseline and weeks 8, 16, and 48 in both groups, with an additional assessment at week 24 (post-MBSR) in the crossover control group. Assessments include self-report and objective measures (e.g., neuropsychological assessment, neurological exam, clinical labs). In addition, a subset of participants (n = 30 per group) are randomly selected to undergo fMRI to evaluate changes in functional connectivity networks and their relationship to changes in neuropsychological outcomes. Forthcoming findings from this randomized controlled trial have the potential to contribute to a growing public health need as the number of older adults with HAND is expected to rise.

Immigrant Generational Differences in Social Support and Sexual Risk Behaviors Among Men Who Have Sex With Men in Seattle, Washington

Different immigrant generations may encounter distinct sexual opportunities with implications for HIV transmission. Yet, few studies have examined how immigrant generational status is associated with sexual risk behaviors among men who have sex with men (MSM). We explored relationships between immigrant generational status, social support, and sexual risk behaviors among English-speaking MSM using data from surveys conducted in Seattle, Washington, in 2014 (n = 323). We compared the sexual risk behaviors and social support of first-generation, second-generation, and third- and higher-generation MSM, and examined whether immigrant generational status and social support were associated with sexual risk behaviors using logistic regression models. Second-generation MSM reported lower friend social support than first- or third- and higher-generation MSM (p < .05). However, immigrant generational status was not associated with sexual risk behavior outcomes, even after accounting for social support. Results suggest that differences in immigration processes such as acculturation may be more predictive of risk behaviors than generational status alone.

Client Perspectives and Experiences With HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis

Patient navigation is increasingly utilized to link and (re)engage persons with HIV to care. Understanding client experiences with HIV patient navigation can facilitate intervention design and translation of evidence to practice. We conducted a qualitative meta-synthesis of client experiences with HIV patient navigation. Data were analyzed using thematic synthesis. We identified seven relevant studies; all collected data via in-depth interviews with persons with HIV who participated in HIV patient navigation. Four interrelated themes emerged from analysis that pertain to (1) the complexity of the health and social service environment and the holistic approaches taken by the navigator, (2) the profound significance of the client-navigator relationship, (3) client reluctance to end the navigation program, and (4) client self-efficacy and feelings of hope and psychological change as a result of their navigation experience. The unifying theme across all studies was the value and impact of the client-navigator relationship on client experience and quality of life. Programs should consider hiring navigators who possess strong relational skills and are peers of the clients, and clearly delineating the role of the navigator. Research should examine the impact of the client-navigator relationship on client outcomes and further investigate how participating in patient navigation affects client self-efficacy, client resiliency, and the role of posttraumatic growth to achieve improved HIV outcomes. This review underscores the significance of the relationship within intensive, multilevel interventions for individuals and communities marginalized and isolated from health and social service systems.

Experiences of social support among persons seeking HIV testing

We interviewed 15 HIV test seekers to understand how social support acted either as a facilitator or barrier to HIV testing. Participants were recruited at community outreach testing sites in South Africa and participated in qualitative interviews which were then analysed using thematic analysis. We identified three main themes, namely, the social phenomenon of perceived risk as a facilitator to HIV testing, social support as a way of managing distress and the public health service as a supportive environment, which all played a role in test-seeking among participants. The results are integrated with the current debates on HIV testing in South Africa.

Social network, social support and the rate of decline of CD4 lymphocytes in asymptomatic HIV-positive homosexual men

Aims: To test a stress-disease hypothesis by investigating the influence of social network and social support factors on the course over time of the CD4 lymphocytes in an HIV-positive population of gay men. Methods: The study is a prospective cohort study of a representative population of HIV-positive gay men, undertaken at the Department of Infectious Diseases, Malmö University Hospital. This is the only clinic providing care for HIV-positive individuals in the city of Malmö in southern Sweden (population 248,000). A total of 115 HIV-positive homosexual men, who had not received an AIDS diagnosis, were invited to take part in the study. Seventy-five men (65%) accepted to be interviewed and 64 men (56%) fulfilled the inclusion criteria for the statistical analysis. Results: In a multivariate analysis adjustments were made for age, level of the first CD4 count and time since first contact with the clinic. Men with high family contact frequency had a longer half-life (20.3 years) of the CD4 lymphocyte count than men with a low family contact frequency (7.4 years) ( p=0.03). Men with high social participation also had a longer half-life of CD4 lymphocyte count (14.7 years), compared with men with low social participation (6.3 years, p=0.10). Conclusions: The findings of this study imply the importance of social support and social network factors as modifiers of the rate of decline of the CD4 lymphocyte level, which is an important prognostic marker of survival in HIV-positive homosexual men.

Gay Men and HIV/AIDS Risk Management

This article presents a framework through which changes in the management of HIV/AIDS risks among British gay men may be conceptualized. Three distinct periods of risk management are outlined. First, a ‘confused’ period in which the aetiology of AIDS and its cultural impact were poorly understood. Second, a ‘somatic’ period is described in which discourses linking HIV risk to the body became prevalent (following the ‘discovery’ of the HIV virus). Finally a third, ‘technological’ period is described which stresses the impact of recent social and medical technologies in the contemporary management of both HIV and AIDS risks. The privatization, fluidity and development of HIV and AIDS ‘risks’ are discussed with particular reference to notions of surveillance medicine, processes of ‘othering’ and the attribution of both responsibility and blame.

'Now and Again It Really Hits Me'

Quantitative and qualitative data were gathered from a sample of 66 seropositive and 67 seronegative men and women about the impact of an HIV diagnosis upon psychosocial well-being. No significant differences between seropositives and seronegatives were found on any of the psychosocial measures except hopelessness. Nor was there significant variation by disease progression (but this may be due to the restricted size of the sample). The qualitative data are used to illustrate these findings and explore their meaning. It is concluded that, with the exception of a hopeless future orientation, psychosocial disturbance of seropositives tends to be episodic and short-lived and thereby difficult to measure.

"Please Don't Make Me Ask for Help": Implicit Social Support and Mental Health in Chinese Individuals Living with HIV

China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.

Social support and condom use among female sex workers in China

While the relationship between social support and psychological well-being has been well established, limited studies have explored how social support might affect condom use among female sex workers (FSWs). Using cross-sectional data from 1,022 FSWs in Guangxi, China, we examined how different forms of support from diverse sources may influence condom use among FSWs. Friends, coworkers, and stable partners were FSWs' main sources of social support. Social support from diverse sources differently impacts FSWs' condom use. Policymakers need to consider the complicated profile of social support received by FSWs and create supportive environment for FSWs to protect themselves from HIV risks.

Social support and HIV-related risk behaviors: a systematic review of the global literature

Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction.

Effect of social networks and well-being on acute care needs

The effect of social surroundings has been noted as an important component of the well-being of elderly people. A strong social network and strong and steady relationships are necessary for coping when illness or functional limitations occur in later life. Vulnerability can affect well-being and functioning particularly when sudden life changes occur. The objective of this study was to analyse how the determinants of social well-being affect individual acute care needs when sudden life changes occur. Empirical evidence was collected using a cross-sectional mail survey in Finland in January 2011 among individuals aged 55-79 years. The age-stratified random sample covered 3000 individuals, and the eventual response rate was 56% (1680). Complete responses were received from 1282 respondents (42.7%). The study focuses on the compactness of social networks, social disability, the stability of social relationships and the fear of loneliness as well as how these factors influence acute care needs. The measurement was based on a latent factor structure, and the key concepts were measured using two ordinal items. The results of the structural model suggest that the need for care is directly affected by social disability and the fear of loneliness. In addition, social disability is a determinant of the fear of loneliness and therefore plays an important role if sudden life changes occur. The compactness of social networks decreases social disability and partly diminishes the fear of loneliness and therefore has an indirect effect on the need for care. The stability of social relationships was influenced by the social networks and disability, but was an insignificant predictor of care needs. To conclude, social networks and well-being can decrease care needs, and supportive actions should be targeted to avoid loneliness and social isolation so that the informal network could be applied as an aspect of care-giving when acute life changes occur.

Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam

BACKGROUND

Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men.

METHODS

In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected.

RESULTS

Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a "scare tactic" mainly focusing on drug users and sex workers, who were defined as "social evils" in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV.

CONCLUSIONS

A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the "social evil" approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

Understanding the biopsychosocial aspects of HIV disclosure among HIV-positive gay men in Scotland

This study presents an interpretative phenomenological analysis of the experiential accounts of HIV-positive gay men. Participants took part in open-ended interviews. Three key-related recurrent themes are presented: ‘Disclosure, deliberation and the abject other’; ‘Disclosure, care and the valued other’ and ‘Disclosure and intimate citizenship’. These highlight the complex, situated and mindful ways in which disclosure occurs. They stand in contrast to the understandings of HIV status disclosure as a ‘health behaviour’ deracinated from its social, relational and emotional dimensions. We explore the findings in relation to contemporary HIV prevention (with its increasing biomedical slant) and in relation to a biopsychosocial framework.

Mastery moderates the negative effect of stigma on depressive symptoms in people living with HIV

Stigma continues to have a negative effect on the care, treatment, and support of people living with HIV. This study presents baseline data from 825 participants taking part in a cohort study that collects data on the clinical profile and social determinants of health of people with HIV. We performed multivariate regression analysis to evaluate whether mastery and social support moderated the negative effect of stigma on depressive symptoms. Stigma was associated with depressive symptoms after controlling for potential demographic and clinical confounders. In addition, higher levels of mastery and social support were associated with lower levels of depression. However, only mastery moderated the negative effects of stigma on depressive symptoms. For individuals with high levels of mastery, greater exposure to stigma does not translate into greater distress. Interventions targeting the mental health concerns of people with HIV should increase their focus on improving people' sense of personal control.

Family support for reducing morbidity and mortality in people with HIV/AIDS

BACKGROUND

Care and support play a critical role in assisting people who are HIV-positive to understand the need for prevention and to enable them to protect others. As the HIV/AIDS pandemic progresses and HIV-seropositive individuals contend with devastating illness, it seemed timely to inquire if they receive support from family members. It also was important to develop a normative idea of how much family support exists and from whom it emanates.

OBJECTIVES

To assess the effect of family support on morbidity, mortality, quality of life, and economics in families with at least one HIV-infected member, in developing countries.

SEARCH STRATEGY

The following databases were searched:The Cochrane Central Register for Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews, MEDLINE, AIDSLINE, CINAHL, Dissertation Abstracts International (DAI), EMBASE, BIOSIS, SCISEARCH, the Cochrane HIV/AIDS group specialized register, INDMED, Proquest, and various South Asian abstracting databases, will be included in the database list. The publication sites of the World Health Organization, the US Centers for Disease Control and Prevention, and other international research and non-governmental organizations. An extensive search strategy string was developed in consultation with the trial search coordinator of the HIV/AIDS Review Group. Numerous relevant keywords were included in the string to get an exhaustive electronic literature search. The search was not restricted by language. Articles from other languages were translated into English with the help of experts. A hand search was carried out in many journals and abstracts of the conference proceedings of national and international conferences related to AIDS (e.g. the International Conference on HIV/AIDS and STI in Africa [ICASA]). Efforts also were made to contact experts to identify unpublished research and trials still underway.

SELECTION CRITERIA

Intervention studies. Randomized control trials (RCTs) and quasi-RCTs involving HIV-infected individuals with family support in developing countries.

DATA COLLECTION AND ANALYSIS

We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria.

MAIN RESULTS

We were unable to find any trials of family support in reducing the morbidity and mortality in HIV-infected persons in developing countries.

AUTHORS' CONCLUSIONS

There is insufficient evidence to bring out the effect of family support in reducing the morbidity and mortality of HIV-infected persons in developing countries. This review has highlighted the dearth of high-quality quantitative research about family support. There is a clear need for rigorous studies of the clinical effects of family support on people with HIV in developing countries.

Test and tell: correlates and consequences of testing and disclosure of HIV status in South Africa (HPTN 043 Project Accept)

BACKGROUND

As the numbers of HIV-positive diagnoses rise in South Africa, it is important to understand the determinants and consequences of HIV disclosure.

METHODS

Cross-sectional survey from random community samples of men and women in urban and rural South Africa (n = 217 HIV-positive individuals, 89% female).

RESULTS

Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s). On average, individuals who disclosed were 2 years older, higher in socioeconomic assets, and had known their HIV status 7 months longer than those who had not told their sexual partner(s). The "need for privacy" was the most cited reason (45%) for nondisclosure among those who had never disclosed. People who eventually disclosed their HIV status to sexual partner(s) were significantly more likely to report always or more frequently using condoms, reducing their number of sexual partners, and/or becoming monogamous. Among individuals who disclosed their HIV status, 77% reported increases in social support, with families providing the most support.

CONCLUSIONS

Disclosure is associated with reports of consequent safer sexual behavior and greater social support. Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner vs. to one's social network.

Medical Treatment for Men Who Have Sex With Men and Are Living With HIV/AIDS

This study focuses on a sample of men who have sex with men (MSM) living with HIV/AIDS in a south Florida community. The study uses a mixed-method, quantitative, and qualitative research design. The purpose of the study was to identify individual and service system characteristics that impact access, retention, and adherence to an HIV/AIDS medical treatment regimen. The study identified many men who were not likely to seek treatment after their initial HIV/AIDS diagnosis. Compared with the general population living with HIV/AIDS in the same south Florida community many of these men were less likely to maintain a regimen of medical care for their HIV/AIDS. The study indicated that the following issues affected medical treatment and treatment adherence: treatment readiness, presence of support networks, availability of “MSM-friendly” health providers, and the cultural competency of substance abuse providers.

Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS

The millions of people living with HIV/AIDS are in urgent need of effective care and support interventions. Such interventions should take people's reported needs, coping strategies, and context into account. Usually, active problem-focused coping strategies have been encouraged because they are considered to be more beneficial than passive emotion-focused strategies. However, this may not be the case in the South African context. This study was based on in-depth interviews with Black, rural, South African women about their coping strategies. The overriding aim of coping was to solve the tasks of physical, psychological, and social survival. Strategies involving avoidance of, escaping from, or minimizing HIV/AIDS and its accompanying emotional distress were predominant. We argue that such strategies could be adaptive in a society with scarce resources and marked by gender inequalities. Our findings suggest that care and support interventions should be sensitive to culture and context, should be holistic and participatory, and should include income generation and child care services.

Social support and disclosure as predictors of mental health in HIV-positive youth

The purpose of this study was to describe mental health symptoms in a sample of 66 HIV-positive youth (ages 16-25) and to evaluate social support, disclosure, and physical status as predictors of symptoms. Data were collected from January 2002 to May 2003. As measured by the Brief Symptom Inventory (BSI), 50% of the youth scored above the cutoff for clinically significant mental health symptoms, thus highlighting the need for mental health services. Lower social support, higher viral load, HIV-status disclosure to acquaintances, and being gay/lesbian/bisexual (GLB) were all significantly correlated with more mental health symptoms, but disclosure to family and close friends and contact with service providers were not. Furthermore, regression analysis showed that social support, viral load, and disclosure to acquaintances predicted 32% of the variance in mental health symptoms. Being GLB was no longer significant, most likely because of shared variance with low social support. Results suggest the importance of mental health interventions, and the potential of social support interventions to improve mental health. Further research addressing the role of HIV-related stigma and homophobia is warranted.

Desenvolvimento de escala para avaliação do suporte social em HIV/aids

O estudo investigou a estrutura fatorial e as propriedades psicométricas da Escala de Suporte Social para Pessoas Vivendo com HIV/aids, elaborada com base em itens de uma escala canadense para avaliação do suporte social em pessoas soropositivas, em iniciativas de pesquisadores brasileiros e na revisão da literatura sobre o construto suporte social. A amostra de validação foi composta de 241 pessoas soropositivas (66,8% homens), com idades entre 20 a 64 anos (M=37,4). A análise fatorial exploratória, pelo método dos fatores principais e rotação oblíqua, indicou a existência de dois fatores de primeira ordem: suporte social emocional (12 itens, alfa=0,92) e suporte social instrumental (12 itens, alfa=0,84). Um fator de segunda ordem composto dos 24 itens originais foi identificado, com bons indicadores psicométricos (alfa=0,87). A estrutura fatorial encontrada correspondeu à estrutura esperada de um instrumento para avaliar as principais dimensões do suporte social em pessoas HIV+.

Exploring direction of causation between social support and clinical outcome for HIV-positive adults in the context of highly active antiretroviral therapy

Social support and its associations with virological outcome were assessed over a 4-year period for 34 adult outpatients living with HIV/AIDS and consistently on highly active antiretroviral therapy (HAART). Clinical variables and perceived availability of social support were measured in three waves (T1, 1997; T2, 1999; T3, 2001). Cross-lagged logistic regression analyses were employed to evaluate the direction of potential causal pathways between social support and clinical status in terms of 'undetectable' viral load. Social support ratings declined moderately overall, with a more pronounced reduction that was of clinical (effect size, 0.82) and statistical significance (p = 0.000) for the subgroup (n = 11; 32%) with final 'detectable' viral load. Evidence suggested causal directionality in which cross-sectional social support and/or improvements in social support over time predicted virological outcome, with better social support associated with greater likelihood of viral load suppression to 'undetectable' level, an outcome achieved for 68% (n = 23) of the sample. In contrast, cross-sectional virological status reflected immunological outcomes but did not predict subsequent ratings of social support or changes in social support ratings. HIV-positive adults consistently taking HAART appeared to experience better clinical benefit if they perceived interpersonal, informational and emotional support to be available, a finding that underscores the importance of social support in relation to treatment outcome for this population.

Social support and quality of life over time among adults living with HIV in the HAART era

Stability in perceived social support and associations between social support and health-related quality of life for a sample of 41 adult outpatients living with HIV/AIDS (PHA) in Canada were assessed longitudinally. Construct-specific dimensions of the Medical Outcomes Study Social Support Survey (SSS), the Physical and Mental components of the Short-Form-36 (SF-36) quality of life measure, as well as clinical factors (i.e., symptomatology, immunologic/virologic variables), were measured in three waves: initial consecutive registration (T1, 1997), 2-year (T2, 1999) and 4-year (T3, 2001) follow-up, and evaluated for changes using repeated-measures analysis of variance, supplemented by Friedman tests for SSS and SF-36 ratings. Proportions of the PHA sample with clinically significant SSS changes (i.e., greater than 0.5 standardized effect size) were also calculated. Effects of improvement versus deterioration in SSS ratings on SF-36 ratings, and vice versa, were explored. Associations between SSS and SF-36 ratings, as well as between changes in SSS ratings and SF-36 ratings, were assessed using multiple regression analyses controlling for clinical factors. Cross-lagged analyses were conducted to examine predictive potential between SSS and SF-36 ratings. Clinical outcomes suggested immunologic improvement tempered by symptoms and/or treatment side effects. SSS and SF-36 mean ratings were moderately stable over time, but clinically significant 4-year decrements in SSS ratings occurred for approximately 40% of patients. A trend occurred in which poorer SF-36 mental outcomes portended poorer emotional and informational support. Otherwise, relations between SSS and SF-36 ratings appeared to be reciprocal. Cross-sectional associations between SSS and SF-36 ratings were more pronounced at T2 compared to baseline and T3. Changes in SSS and SF-36 ratings were somewhat related over the consecutive 2-year periods but not over the long term. T1-T2 SSS changes were associated with changes in the SF-36 mental component. T2-T3 SSS changes were associated with changes in the SF-36 physical component. Cross-lagged analyses yielded little explanation concerning direction of causation in terms of associations between social support and quality of life for the PHA in this study.

Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women

Patterns of HIV-status disclosure and social support were examined among 331 HIV-positive men and women. Structured interviews assessed HIV-status disclosure to family and friends, perceived stress of disclosure, social support, and depression. Results showed patterns of selective disclosure, where most participants disclosed to some relationship members and not to others. Rates of disclosure were associated with social support. Friends were disclosed to most often and perceived as more supportive than family members, and mothers and sisters were disclosed to more often than fathers and brothers and perceived as more supportive than other family members. Path analyses tested a model of HIV-status disclosure showing that perceived stress of disclosing HIV was associated with disclosure, and disclosures were related to social support. Disclosure and its association to social support and depression varied for different relationships and these differences have implications for mental health and coping interventions.

Informal networks among women with HIV/AIDS: present support and future prospects

Given the importance of informal support in the lives of chronically ill people, it is imperative to gain a deeper understanding of the nature and impact of HIV-positive women's informal networks. Through interviews with 37 women with HIV infection, the author explores women's social network composition and the extent to which these networks appear to facilitate or mediate the disruption caused by HIV/AIDS. Women reported having at least one person, usually a family member, on whom they could depend for emotional support. Although women report adequate levels of current support, the author questions the likelihood that their informal networks will provide support further along in women's illness trajectories.

Reductions in herpes simplex virus type 2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men

OBJECTIVE

Coinfection with herpes simplex virus type 2 (HSV-2) is common in individuals infected with human immunodeficiency virus (HIV) and may have health implications. This study examined the effect of a 10-week cognitive behavioral stress management (CBSM) intervention on immunoglobulin G (IgG) antibody titers to HSV-2 in a group of mildly symptomatic HIV-infected gay men and the degree to which these effects were mediated by psychosocial and endocrine changes during the 10-week period.

METHODS

Sixty-two HIV+ gay men were randomly assigned to either a 10-week CBSM intervention (N = 41) or a wait-list control condition (N = 21). Anxious mood, social support, cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratio levels, and HSV-2 IgG antibody titers were assessed at baseline and after the 10-week period. CBSM participants also recorded their stress levels before and after at-home relaxation practice.

RESULTS

HSV-2 IgG titers were significantly reduced in the CBSM participants but remained unchanged in the control group after the 10-week intervention period. Increases in one type of social support, perceived receipt of guidance, during the 10 weeks was associated with and partially mediated the effect of the intervention on HSV-2 IgG. Similarly, decreases in cortisol/DHEA-S ratio levels were associated with decreases in HSV-2 IgG, and lower mean stress levels achieved after home relaxation practice were associated with greater decreases in HSV-2 IgG among CBSM participants.

CONCLUSIONS

These findings suggest that behavioral and psychosocial changes occurring during CBSM interventions, including relaxation, enhanced social support, and adrenal hormone reductions, may help to explain the effects of this form of stress management on immune indices such as HSV-2 antibody titers.

Psychological discomfort and mental illness in patients with AIDS: implications for home care

A chart review study of 100 consecutive AIDS patients cared for by our Home Care (HC) unit was performed. The main characteristics of the sample were: M/F ratio = 3/1; mean age = 39.7 +/- 6.6; mode of transmission = 56% intravenous drug users (IVDU); Centers For Disease Control (CDC) classification = 98% C3; mean length of HC = 5.2 months. Psychopathological evaluation led to an overall rate of morbidity during HC of 73%. The most common psychiatric diagnoses were dementia and adjustment disorders. Nearly two thirds of the patients received psychopharmacological treatment; one fifth were still on methadone. Psychological discomfort was perceived by more than half of patients. Interpersonal problems with cohabitants were noticed by caregivers in 41%. Female patients showed an increased prevalence of anxiety and depressive disorders. IVDUs had more prominent psychosocial problems. Interpersonal problems with cohabitants were correlated to substance use or other mental disorders in the family and to the patient's psychological discomfort. We conclude that mental health professional intervention for AIDS patients is strongly needed in a home-care setting.

Description and validation of a measure of received support specific to HIV

Validation data are described for the Social Support Inventory for People who are HIV Positive or Have AIDS. This inventory was developed specifically for use with individuals who are HIV-positive to assess three types of received support (instrumental, informational, emotional) for each of four dimensions: whether support is received or wanted, satisfaction with support, and source of the support. It was validated in the context of a larger cross-sectional study of 120 adults with HIV who completed a set of questionnaires. Descriptive statistics, internal consistency coefficients, and evidence of construct validity for the original inventory are presented. An improved, revised version based on the validation data for the original one is also briefly described, but not tested.

Support groups for people living with HIV/AIDS: a review of literature

For more than a decade, support groups have been proposed as a key intervention for people living with HIV and AIDS (PLWAs). Despite this fact, there are still only a few articles that evaluate and compare outcomes of support groups so as to provide a scientific base for their usefulness and effectiveness. The purpose of this article is to critically review selected published literature on support groups and to assess gaps in research. In general, the reviewed literature evaluated support groups as an effective intervention, which is evident for this widespread support. However, because diverse populations of PLWAs have specific needs, the group and intervention should be designed to meet those needs. Specific recommendations for further research about support groups for PLWAs are offered.

Dirty, diseased and undeserving: the positioning of HIV positive women

The discursive construction of HIV/AIDS associates deviance and disease. Women living with HIV/AIDS, in particular, have been positioned as a source or potential source of infection, and have attracted guilt and blame: in becoming 'disease' they have failed in their appropriate roles as carers and nurturers, responsible for the next generation. Based on in-depth interviews with 27 women living with HIV/AIDS this paper focuses on three ways of positioning HIV positive women: through discrimination on the part of medical professionals; through internalisation of stigmatisation; and through multiple stigmatisation of women who are or have been illicit drug users or sex workers. The implications of stigmatisation are discussed in relation to accessing health care and support.

The role of social support in HIV infection

A study was carried out in a group of 91 HIV positive gay men to investigate the relationship between social support, measures of affect and health; the changing nature of support over time; and the causal direction of this relationship. Overall levels of support for this group were found to be moderately high and consistent over 6 months and were associated with greater psychological well-being. Individuals in receipt of quantitatively different levels of support were found to differ on measures of depression, stress, coping efficacy and self-esteem, while individuals in receipt of deficient levels of support were found to be more depressed. However, initial support levels were found to be the most powerful predictors of subsequent support levels. The implications of these findings are discussed.

Identifying helpful and unhelpful behaviours of loved ones: the PWA's perspective

Twenty-five gay men with AIDS were interviewed about their social support networks and asked to describe specific interpersonal exchanges with network members which they perceived to be helpful and unhelpful. Content-analysis of responses revealed 12 main categories of helpful behaviours (providing encouragement, companionship, information, practical assistance, material aid, philosophical perspective, support for other network members, expressing concern, sharing feelings, acting as role model, allowing reciprocity, interacting naturally) and 11 categories of unhelpful behaviours (pessimism, physical avoidance, criticizing one's response to AIDS or medical treatment, making unreasonable demands, patronizing attitude, rude comments, insincerity, breaking confidentiality, acting judgmental or ashamed). The perceived helpfulness of particular behaviours varied depending on which network member performed them and the timing of the support attempt. Implications for increasing the effectiveness of support attempts by network members are discussed.