Social support and health outcomes among individuals living with HIV in the Deep South
ABSTRACTSARA HAYES LEGRAND. Social support and health outcomes among individuals living with HIV in the Deep South. (Under the direction of DR. TERESA L. SCHEID) Study Purposes: The purposes of this study were: 1) to provide a more comprehensive description of social support and to determine if gender and/or race were associated with social support; 2) to examine relationships between diverse forms of social support and health outcomes such as mental health, HIV disease severity, and physical quality of life; and 3) to analyze gender and racial differences in the associations between social support and health outcomes among individuals living with HIV in the Deep South. Methods: Baseline data from the Duke University Coping with HIV/AIDS in the Southeast (CHASE) Study collected in 2001-2002 were used for this study. Multivariable models based on the Commission for Social Determinants of Health Conceptual Framework were constructed to examine the associations between gender, race, and social support and social support and health outcomes. Stratified analyses were conducted to identify differences in the associations between social support and health outcomes by gender and race.Results: Men were more likely to be socially isolated than women. Non-Hispanic Black individuals were more likely to experience social conflict than non-Hispanic Whites. Greater perceived social support was associated with less psychological distress and exposure to social conflict was associated with more psychological distress. A higher degree of social integration was associated with larger CD4 count values. Interactions between severe stress and perceived social support and severe stress and social isolation were associated with physical health-related quality of life. The strongest predictor of psychological distress among males was perceived social support, while social conflict was the strongest predictor of distress for women. Social conflict was also the strongest predictor of physical health-related quality of life among women. There was a significant difference in the relationship between social conflict and physical health-related quality of life for men and women. For non-Hispanic White individuals, social isolation was associated with physical health-related quality of life, but not for non-Hispanic Blacks. The relationship between social isolation and health-related quality of life was significantly different by race. Conclusions: Multiple components of social support were associated with health outcomes in this study. Although HIV care has traditionally addressed the social needs of clients, medical treatment has increasingly become the focus of care. Reductions in financial support for social support services necessitate improvements in the effectiveness and efficiency of funded social support interventions. Identification of the components of social support that predict health outcomes for HIV-positive individuals living in the Deep South may inform intervention development or guide modifications to existing interventions. Knowledge about the differences in these associations by gender and race may further improve interventions and help identify the highest priority populations. In addition to efforts to improve social support interventions, the health effects of policies that reduce funding to address the social support needs of individuals living with HIV should be carefully evaluated.