Understanding the Relationships of Social Support, Mental Health Needs, and HIV Risks: A Gender-Specific Analysis

Background and Purpose: The HIV/AIDS epidemic remains a challenge to healthcare systems in the United States and worldwide. According to Centres for Disease Control (2018), more than 1.1 million individuals in the United States were living with HIV at the end of 2015. Syndemic theory posits that HIV/AIDS often coexists and interacts synergistically with one or more afflictions, which contributes to the excessive disease burden. Given that as high as 18% of adults have a mental health condition in the United States, it is important to understand whether mental health concerns co-exist with HIV-related risk behaviors from the syndemic perspective. Furthermore, social support has been proposed as a protective factor for both mental health concerns and HIV risks. Using a population-based data and gender-specific analysis, we hypothesized that: 1) mental health needs are positively correlated with HIV risks; and 2) social support moderates the association support between mental health needs and HIV risks.

Methods: We analyzed the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) data from four states (Louisiana, Michigan, Rhode Island, and Tennessee) that included the optional social and emotional support module in their BRFSS. We weighted the data using population weights and sampling units. The total sample consists of 33,705 individuals (14,796 males and 18,909 females). Logistics regressions first evaluated the associations between mental health and HIV behaviors, followed by the assessment of the contribution of social support and the interaction term of mental health and social support in the logistic regression models. All models were stratified by gender and controlled for demographic variables.

Results: More males than females were engaged in HIV risk behaviors (7.4% versus 4.8%, p<.0001), while more females than males had mental health needs (40.3% versus 29.5%, p<.0001). For hypothesis 1, the odds of engaging in HIV risk behavior were positively associated with mental health needs across both males (OR=1.50, 95%CI=1.27-1.79, p<.0001) and females (OR=2.18, 95%CI=1.78-2.67, p<.0001). For hypothesis 2, while social support was negatively correlated with HIV risks for both genders (male model: OR=0.70; 95%CI=0.55-0.90, p<.01; female model: OR=0.70, 95%CI=0.60-0.82, p<.0001), the interaction term of mental health and social support was found only significant among males (OR=0.73, 95%CI=0.57-0.93, p<.01), but not among females. Inspection of the moderation graph shows that males with low social support and strong mental health needs had the highest odds of HIV risks relative to those who had medium or high social support.

Conclusions and Implications: Study findings provide support to the syndemic theory and underscore the co-occurrence of HIV risks and mental health needs. Surprisingly, while social support is linked with decreased HIV risks, it only serves as a buffer for males who have mental health needs, but not for females. The study lends support for programming that aims to increase social support for males who are at risk for HIV risks. Future studies should continue to understand the mechanisms that can help mitigate the syndemics of HIV risks and mental health needs for females.