People living with HIV/AIDS (PLWHA), particularly BIPOC, in the US South are disproportionately impacted by HIV (CDC, 2019). Concurrently, the COVID-19 pandemic has changed the landscape of HIV care, causing delays in care and increased social isolation, leading to negative HIV health outcomes (Pinto et al., 2020). Scholars have documented that increased social networks and decreased social isolation leads to improved HIV care engagement (Geng at al., 2010; Salmen et al., 2015) and quality of life (Yoo-Jeong, 2022). Existing research overwhelmingly examines individual factors (e.g., depression, condom use). It is clear, however, that multilevel factors (e.g., social support, stigma) are critical to one’s well-being and HIV health outcomes. To achieve equity and justice, it is imperative to understand and change these systems and structures that often marginalize PLWHA. The aim of this study is to examine the multilevel factors associated with social networks among PLWHA in the US South.
We used baseline survey data (n=111) from a HRSA-funded project aimed at improving housing, employment, and HIV health outcomes among PLWHA in a large Southern US city. Intrapersonal (i.e., anxiety), interpersonal (i.e., social support, living with others, trust in healthcare provider), and structural (i.e., lack of transportation, anticipated stigma, LGBTQ stigma) factors were predictor variables, and social network was the outcome variable. The Lubben Social Network scale was used to measure social networks (Lubben et al., 2006). Researchers conducted bivariate analyses and multivariate linear regression to explore multilevel factors associated with social networks.
The sample was predominately comprised of Black/African American cis-gender men (n=64, 58%) who were 38 years old on average (SD=10.82). 94% were unstably housed and 80% were unemployed. The regression model for social networks was significant, F (2,501) = 3.652, p = .002, and accounted for nearly a third of the variance (R2=.302). Of the seven predictor variables, three were statistically significant: social networks was positively associated with social support (β=.354, p=.011), but negatively associated with needing transportation assistance (β=-3.802, p=.018), and LGBTQ stigma (β=-2.978, p=.019).
Conclusions and Implications
This study found that two structural variables (needing transportation assistance and LGBTQ stigma) and one interpersonal variable (social support) were significantly associated with social networks among PLWHA. Participants who reported higher levels of LGBTQ-related stigma and needing transportation assistance were more likely to report increased feelings of social isolation. On the other hand, respondents who reported feeling socially supported were likely to report decreased feelings of social isolation. These findings indicate the need to critically appraise multilevel factors as they impact feelings of social connectedness among PLWHA in order to achieve equity. In an effort to build solutions to address inequities, recommendations include: (1) addressing LGBTQ stigma to help improve feelings of social connectedness; (2) increasing access to transportation support to decrease feelings of social isolation; and (3) providing social support to individuals so they may also experience social connectedness.