Exploring Social Network Relationships and Types of Social Support Among Young Adults with HIV: A Systematic Literature Review

Background and Purpose: Young adults with HIV (YAHIV; 18-25 years old) make up a large proportion of individuals diagnosed with HIV in the United States and worldwide. Furthermore, many YAHIV have recently transitioned from pediatric to adult HIV care or are approaching the age in which they will need to transition to adult care. This is a particularly vulnerable period along the HIV care continuum, especially since a large proportion of YAHIV fall out of care following HIV care transition. Although previous research indicates that transition preparation and the patient-provider relationship play significant roles in facilitating successful healthcare transition (HCT) among young adults living with HIV (YAHIV), there is limited exploration in the literature regarding the potential impact of other social relationships, specifically social networks, on optimal HIV care utilization during this pivotal period. Thus, the overarching questions guiding this review included: Who are the key social relationships that make up the social networks of YAHIV, and what types of supports and negative influences do these relationships provide to YAHIV in the context of HIV care?

Methods: The review consisted of a systematic search of the published articles and dissertation studies from 2004 to 2023. The search generated 879 articles from four databases which were imported into Covidence. Following abstract and full-text review and removal of duplicate studies, 28 studies were included for final analysis. Content analysis aided in identifying social network members and types of social support YAHIV received in the included studies.

Results: Among the 28 articles included in the final review, half (50%) were studies based in the U.S., 25% were conducted in multiple African countries, and the remaining studies were conducted in Asia and South America. Over half of included studies utilized qualitative methods to investigate YAHIV, while 35.7% solely used quantitative methods. The remaining studies used mixed methods approaches (7.1%) and comprehensive literature review methodologies (3.6%). Of particular interest, there was no unifying theoretical perspective that guided the included studies; however, social capital theory was latently applied among several studies to conceptualize types of social supports (e.g., informational, instrumental, emotional) across studies. The most commonly identified network members included family, caregivers, and friends/peers. YAHIV tended to rely on friend/peer networks in the absence of familial support. Further, many YAHIV among the included studies established important peer connections in the context of their pediatric HIV clinics. HIV-related stigma was a pervasive barrier to HIV-disclosure and optimal health behaviors including antiretroviral medication adherence and attending medical appointments.

Conclusions: To the best of my knowledge, this is the first comprehensive literature review that explicitly seeks to identify key social network members and types of social support. The identification of social network members among YAHIV and the types of social support they provide serves as a foundation for future prevention and intervention studies that aim to mobilize critical social supports from informal network members to achieve positive health outcomes among YAHIV surrounding HIV care transition.