Social Network Correlates of Depressive Symptoms and Perceived Social Support Among HIV-Positive Men

Background and Purpose: Social isolation is a major problem for HIV-positive men, who may experience stigma and discrimination following disclosure of their HIV status. Social support can increase medication adherence, alleviate depression, and diminish stigma associated with HIV diagnosis. Little is known about the social networks of HIV-positive men despite the importance of this information for interventions to reduce health risks. This study seeks to document the structure and composition of HIV-positive men’s networks and determine inclusion of key sources of social support for future social network interventions. We hypothesize that HIV-positive men with larger social networks will have fewer depressive symptoms and higher perceived support.

Methods: HIV-positive men ages 18 and older were recruited from social service agencies throughout Los Angeles County (N=111) and invited to participate in a cross-sectional interview at a community location convenient to the participant. A social network interview (SNI) using an iPad application and subsequent computer-assisted survey focused on demographic characteristics, health history, HIV care and medications, and social support. Egocentric networks variables were created and standardized by dividing the number of ties of a given alter type by the overall network size. Multivariate associations between network alter type and depression (using the 10-item CES-D, α=0.75) and social support (using the 12-item Multidimensional Scale of Perceived Social Support, α=0.94) were analyzed using ordinary least squares regression in SPSS, Version 22.0 adjusting for age and race/ethnicity.

Results: Participants had a mean age of 46.0 (SD=10.0) and were predominantly Latino (55.0%), Black (31.5%) or White (9.9%). Over two thirds identified as gay (69.4%), over half (58.6%) had been diagnosed with AIDS, and 60.1% reported HIV viral load suppression. Participants reported 10.4 network members, including an average of 3.5 family members, 2.3 caseworkers and 1.0 medical professionals. Larger network size was associated with lower depressive symptoms (b=-0.20, p<0.05) and greater perceived social support (0.69, p<0.05). Having more network alters who made the participant feed liked or loved (b=-4.17, p<0.05) and made the participant feel respected or admired (b =-4.39, p<0.05) was protective against depressive symptoms. In addition, having more alters with whom the participant texted or communicated with via computer (e.g., email, Facebook) was associated with lower depressive symptoms (b=-4.63, p<0.05; b=-4.14, p=<0.05). Having a caseworker, social worker, therapist or agency staff member in one’s network was the strongest predictor of perceived social support (b=-35.19, p<0.01).

Conclusions and Implications: Interventions to reduce depression and increase perceived social support among HIV-positive men are needed to improve the overall health and longevity of this population. Our findings demonstrate the potential utility of network-based interventions for HIV-positive men that capitalize on existing social network ties. Those who demonstrate love and respect toward HIV-positive men may be especially useful for the transmission of health-related information (i.e., network induction). Additionally, professionals or paraprofessionals addressing the psychosocial needs of HIV-positive men may reduce depressive symptoms and increase support (e.g., network alteration). Network interventions that include health messaging delivered through technology (e.g., text message, Facebook) should be explored in future research.