The Social Networks of HIV-Positive Women and Their Influence on Social Support and Depressive Symptoms

Background: Previous work with HIV-positive individuals has found that their emotional health is better when they report more perceived and actual social support. Greater social support is associated with less depression, anxiety, and loneliness; size of networks is linked with better quality of life. Depth and composition of networks influence the quality and quantity of social support; experiences with disclosure have the potential to decrease the size of social networks, reduce the amount or types of social support received from network members, or both. As social support is known to positively influence the mental health of HIV-positive women, this study examined the composition of HIV-positive women’s social networks, how women describe network members, and the ways in which they use their networks for social support.

Methods: In summer 2012, pilot data were collected from 47 HIV-positive women in Los Angeles who received services at service organizations. To gather social network data, the interviewer used the Social Network Interview iPad application which provides a visual stimulus to enhance the participant’s ability to provide social network data. First, participant was asked to nominate significant others in their social network. Second, the iPad application generated a visual of the participant’s social network. Questions relevant to the social network appeared along the bottom of the screen. Measures included disclosure of HIV-status and perceived social support. Complimentary items collected via survey included basic demographics, and a HIV-stigma and a depressive symptoms scale. Statistical analysis proceeded in two stages. First correlation coefficients were calculated between each network composition variable and depression, family and friend support, personal stigma, and disclosure fears. During the second stage, ordinary least squares multivariable regression was conducted to assess associations between network variables and depression, stigma and perceived support.

Results: On average, women reported 17.4 network members, including 9.85 individuals they considered friends and 7.78 family members. They also reported formal network linkages, nominating on average 1.20 doctors, 2.17 caseworkers, and 1.26 therapists/social workers. Related to social support, participants nominated an average of 2.35-4.39 individuals who provide instrumental support and received emotional support from an average of 6.30 individuals. Depressive symptoms were positively associated with an increased number of doctors reported in a woman’s network and negatively associated with a greater number of HIV-positive women in the network. Support from friends was associated with a greater sense of instrumental support. Lastly, there was a significant negative relationship between fears about disclosure and number of network members who women reported made them feel loved.

Discussion: While there are known benefits of social support on the mental health of HIV-positive persons, few have systematically collected social network data, limiting our understanding of network characteristics and ways in which networks provide various types of support. This work highlights the ways in which social network data increases our understanding of the ways in which social support is provided to HIV-positive women. This knowledge creates opportunities to pinpoint interventions to support the behavioral health of these women, particularly the on-going need for support from other HIV-infected persons.