Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study

Abstract

Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support; effects of social support on HIV viral load; and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy (ART) who were enrolled in the Multicenter AIDS Cohort Study between 2002—2009 (n=712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (ICC=0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p<.0001). Recent sero-conversion was associated with higher social support (p<.05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p<.0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p<.0001). Social support moderated the relationships between syndemic and HIV viral load (p<.05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.

Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services

“…There is consistent evidence that social networks exert strong social influence on the engagement of network members in the HIV Care Continuum 21–23 . In addition to stigma affecting HIV infection, MSM often are affected by stigma related to sexual practices and sexual orientation 24,25 .…”

“…Stigma is a fundamental barrier to engagement into HIV care and negatively impacts patient outcomes 11,12 . Social support systems reduce stigma, improve individual acceptability of HIV infection, as well as successful navigation throughout the HIV Care Continuum pathway 23,26 . Instrumental support such as provision of financial assistance, emotional support such as comfort, and informational support such as advice on dealing with difficult situation may have facilitated the uptake of HIV testing, initiation of ART and eventual viral suppression in this cohort.…”

“It's Almost Like a Crab-in-a-Barrel Situation”: Stigma, Social Support, and Engagement in Care Among Black Men Living With HIV

“…For example, among PLWH, social support is directly and indirectly associated with greater treatment adherence (DiIorio et al, 2009; Kelly, Hartman, Graham, Kallen, & Giordano, 2014; Woodward & Pantalone, 2012). Greater social support (perceived and received social support) is associated with lower viral load and greater viral suppression among PLWH (Amberbir, Woldemichael, Getachew, Girma, & Deribe, 2008; Friedman et al, 2017; Simoni, Frick, & Huang, 2006). Furthermore, at the time of HIV diagnosis, social support may be a critical factor in facilitating initiation and engagement in HIV care (Lauby et al, 2012), facilitating ART adherence (Latkin et al, 2013), and improving coping with HIV-related stressors (Lam, Naar-King, & Wright, 2007; Power et al, 2003).…”

“…Yet, research has indicated that the availability of social support may be limited for some African Americans (Friedman et al, 2017), who are more likely to report smaller social networks compared with White men (Kapadia et al, 2013). This may stem, in part, from stigma, a pervasive social process which is negatively associated with social support among PLWH (Farber, Lamis, Shahane, & Campos, 2014; Mak et al, 2007; Simbayi et al, 2007; Simbayi et al, 2007).…”

Can Burt’s Theory of Structural Holes be Applied to Study Social Support Among Mid-Age Female Sex Workers? A Multi-Site Egocentric Network Study in China

“…However, the key to the success of the two intervention strategies is adequate adherence to treatment and PrEP. Because the life-long use of anti-viral drugs requires sufficient support from social network and environment (policy support and medical service) (59), the social network factors embedded in the environments of users may either facilitate and/or impeded adherence. HIV/AIDs interventions need to address the three types of social networks around mid-age FSWs, the structures of networks, redundant and non-redundant connections, and their environmental resources.…”