Barriers to social support for persons living with HIV/AIDS

The purpose of this study was to test a barrier theory of perceived social support to HIV-positive gay men. The proposed model was tested for friends and family separately in order to investigate the uniqueness each provided. In both models, it was hypothesized that the presence of barriers to social support (availability, intimacy and disclosure) diminished acquisition of social support. The influence of barriers on the relationship between social support and health outcome (i.e. depression, t-cell count) for both friend and family models was also investigated. In general, data from HIV-positive gay men support barrier theory premises for both family and friends. Implications for helping professionals and researchers are proposed.     

Self-Esteem in HIV-Positive and HIV-Negative Gay and Bisexual Men: Implications for Risk-Taking Behaviors with Casual Sex Partners

Research suggests that self-esteem in gay and bisexual men may be linked with sexual risk-taking behaviors. As part of a larger investigation into the sexual practices of gay and bisexual men, we assessed serostatus, self-esteem, condom use, and HIV disclosure to sexual partners. Among HIV-negative men, no relationships were found between their self-esteem and tendency to discuss their and their partners’ HIV status. However, among HIV-positive men, there was a positive relationship between self-esteem and disclosure to receptive and insertive anal sex partners. These results suggest greater attention to the self-esteem of HIV-positive men by attending healthcare workers and social support groups.     

Social Network Predictors of Disclosure of MSM Behavior and HIV-Positive Serostatus Among African American MSM in Baltimore,Maryland

This study examined correlates of disclosure of MSM behavior and seropositive HIV status to social network members among 187 African American MSM in Baltimore, MD. 49.7% of participants were HIV-positive, 64% of their social network members (excluding male sex partners) were aware of their MSM behavior, and 71.3% were aware of their HIV-positive status. Disclosure of MSM behavior to network members was more frequent among participants who were younger, had a higher level of education, and were HIV-positive. Attributes of the social network members associated with MSM disclosure included the network member being HIV-positive, providing emotional support, socializing with the participant, and not being a female sex partner. Participants who were younger were more likely to disclose their positive HIV status. Attributes of social network members associated with disclosure of positive serostatus included the network member being older, HIV-positive, providing emotional support, loaning money, and not being a male sex partner.     

Stress buffering effects of family support in AIDS caregiving

This study examines the effects of family support on AIDS caregiver stress over time, comparing HIV-positive and HIV-negative gay-identified men who care for a friend or partner living with HIV (PLWH). Support from the care-recipient's family of origin is assessed, and the stress buffering effects of this type of support are explored longitudinally within a stress proliferation framework for 276 men (114 were HIV-positive, 162 were HIV-negative). Among HIV-positive caregivers, emotional distress is associated with high caregiving stress and low PLWH family support. Emotional distress among HIV-negative caregivers is also associated with caregiving stress, but is not significantly influenced by support from the PLWH's family. For both groups, increasing emotional distress over a seven-month period is a function of increasing caregiver stress, but not PLWH family support. The effects of financial worry and role overload on caregiver emotional distress are conditional upon PLWH family support at Time 1 among HIV-positive caregivers, such that support buffers the distressing impact of financial worry, but may exacerbate the distressing impact of role overload. In addition to characterizing processes of stress proliferation and social support, this research also illustrates how families of choice and families of origin simultaneously shape the experience of the caregiving role and its influence on the wellbeing of gay men.     

Coping with death anxiety: help-seeking and social support among gay men with various HIV diagnoses.

OBJECTIVE, DESIGN AND PARTICIPANTS: We examined sources of help-seeking related to worries or concerns about death and dying and the effects of social support on death anxiety in a longitudinal sample of gay men (n = 52). RESULTS: Friends and primary sexual partners were the most frequent sources sought in dealing with death concerns for all groups of respondents (HIV-negative, HIV-positive asymptomatic, and HIV-positive symptomatic). Men experiencing HIV symptoms were more likely than HIV-negative and asymptomatic men to use formal sources of support (medical, psychological). Although HIV-positive symptomatic men did not differ from HIV-negative men in terms of help-seeking from family sources, they were significantly more likely to seek the help of family members than HIV-positive asymptomatic men. All three HIV groups showed significantly different mean levels of death anxiety, with HIV-negative men reporting the lowest level and HIV-positive symptomatic men the highest. Among HIV-negative men, only mental health sources of support (psychologists and clergy) were significantly related to death anxiety, measured 1 year later (beta = -0.35). These sources of support were also associated with death anxiety among HIV-positive asymptomatic men, but in the opposite direction (beta = 0.26). Contrary to expectations, men experiencing HIV symptoms benefited most from family support (beta = -0.31), although peer (beta = -0.19) and medical (beta = -0.28) support sources were also prominent. CONCLUSIONS: Thus, while earlier research found peers to be the most common and effective source of support among gay men, this study suggests that obtaining support from family may become particularly important as one approaches death. The effectiveness of social support in reducing death anxiety appears to vary over the course of the disease from asymptomatic to symptomatic. HIV-symptomatic men obtain support from a wide range of helpers, including medical and peer supports and family.     

Effect of antiretroviral treatment and counselling on disclosure of HIV-serostatus in Johannesburg, South Africa

This prospective non-randomized study of clinic attendees, compares self-reported HIV disclosure patterns in relation to access to antiretroviral access and counselling. It was carried out in public sector hospital HIV clinics in Johannesburg, South Africa, and 144 HIV-positive men and women attending the HIV clinics participated in the study.The results showed that there was no correlation between being on antiretroviral therapy and disclosure of HIV status. There was also no correlation between disclosure of HIV status and with different levels of counselling and access to support groups. Disclosure levels were high (92% told at least one person), however, there was a high level of delayed (15% greater than a year) or non-disclosure (21%) to partners. Family members and partners provided most moral support after disclosure. Having access to antiretroviral therapy and support groups and available counselling did not seem to affect disclosure patterns. It is possible that a patients beliefs about their treatment plays a more important role for disclosure than the actual treatment itself. Other factors are also likely important for disclosure, such as the patient's social network especially with their families, and knowledge of the disease.     

Differences in disclosure of sexuality among African American and White gay/bisexual men: implications for HIV/AIDS prevention.

Gay and bisexual men were asked if they had disclosed their sexuality to family members, heterosexual friends, gay friends, coworkers, health care workers, and members of their church; if they had been associated with groups made up of gays, bisexuals, and lesbians; and if they had gay/bisexual friends. White men were much more likely to disclose their sexuality, to have associated with groups and to have gay/bisexual friends. As education increased, white men were more likely, and African American men less likely, to disclose sexuality and associate with groups. Having gay/bisexual friends increased with education with both groups. The difference in disclosure can be traced to the higher social stigma apparently attached to being gay in the African American community, which may be exacerbated for more educated men. As a result, African American gay men may be less likely to participate in the fight against HIV/AIDS.     

Rate, pattern and barriers of HIV serostatus disclosure in a resource-limited setting in the Niger delta of Nigeria

The disclosure of HIV serostatus is a difficult emotional task creating opportunity for both support and rejection. In this study, we evaluated the rate, patterns and barriers to HIV serostatus disclosure. A pre-tested interviewer-administered questionnaire from 187 HIV infected people residing in a resource-limited setting in the Niger Delta of Nigeria was analysed. Of the 187 HIV seropositive patients studied, 144 (77.0%) had disclosed their HIV-serostatus while 43 (23.0%) had not. Results showed that the patients had disclosed their HIV-serostatus to: parents (22.3%), siblings (9.7%), pastors (27.8%), friends (6.3%), family members (10.4%) and sexual partners (23.6%) (P = 0.004). Females were more likely (59.7%) to disclose their HIV serostatus compared with males (40.3%) (P = 0.003). Mothers were twice as likely (65.6%) to be confided in compared with fathers. Barriers to HIV serostatus disclosure included fear of stigmatization, victimization, fear of confidants spreading the news of their serostatus and fear of accusation of infidelity and abandonment (P = 0.002). Married respondents were more likely to disclose their status. Better-educated respondents with tertiary education were more likely to disclose their HIV-serostatus. Expectation of economic, spiritual, emotional and social support was the major reason for disclosure. The ratio of disclosure to non-disclosure among patients with non-formal education was (2.6:1.0), primary education (2.3:1.0), secondary education (3.3:1.0) and tertiary education (10.0:1.0). Disclosure of HIV serostatus can foster economic social and economic support. There is need for the re-intensification of interventional measure that combines provider, patients and community education particularly in the aspect of anti-stigma campaign, partner notification and skill building to facilitate appropriate HIV serostatus disclosure.     

An examination of the HIV serostatus disclosure process among Haitian immigrants in New York City

Little is known about the HIV serostatus disclosure experience of Haitian immigrants in the USA. We employed the disclosure processes model to examine the disclosure experience of 21 HIV-positive Haitian immigrants in New York City. Data were collected through in-depth interviews conducted between May 2012 and January 2013 with participants from four community-based organizations providing HIV/AIDS services. Analysis of the interviews yielded several enablers relevant to reasons for disclosure including participants being in a close relationship with someone they trusted or felt comfortable with, and the need for support and understanding about the illness. Some of the barriers to HIV serostatus disclosure were fear of being stigmatized, rejected. For participants who had disclosed to significant others in the USA and in Haiti, they reported that they experienced both positive and negative outcomes including social support, emotional relief, encouragement to take their medication, and on some occasions mistreatments, isolation, and stigma. The strategies participants employed during the disclosure event also revealed the additional challenges immigrants face when deciding to disclose their HIV serostatus to family members living in their country of origin. These findings suggest the need to develop culturally appropriate interventions to address the disclosure needs of ethnic minorities residing in the USA.     

Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda

Under international, regional, and domestic law, adolescents are entitled to measures ensuring the highest attainable standard of health. For HIV/AIDS, this is essential as adolescents lack many social and economic protections and are disproportionately vulnerable to the effects of the disease. In many countries, legal protections do not always ensure access to health care for adolescents, including for HIV/AIDS prevention, treatment, and care. Using Rwanda as an example, this article identifies gaps, policy barriers, and inconsistencies in legal protection that can create age-related barriers to HIV/AIDS services and care. One of the most pressing challenges is defining an age of majority for access to prevention measures, such as condoms, testing and treatment, and social support. Occasionally drawing on examples of existing and proposed laws in other African countries, Rwanda and other countries may strengthen their commitment to adolescents' rights and eliminate barriers to prevention, family planning, testing and disclosure, treatment, and support. Among the improvements, Rwanda and other countries must align its age of consent with the actual behavior of adolescents and ensure privacy to adolescents regarding family planning, HIV testing, disclosure, care, and treatment.     

HIV disclosure by men who have sex with men to immediate family over time

Previous researchers have comprehensively documented rates of HIV disclosure to family at discrete time periods yet none have taken a dynamic approach to this phenomenon. The purpose of this study was to address the trajectory of HIV serostatus disclosure to family members. Time to disclosure was analyzed from data provided by 135 HIV-positive men who have sex with men. Results indicated that mothers remain the family member to be told in greatest proportion, yet the proportion of family members told changes over time in a different manner than presented in earlier research. Additionally, the rate at which family members are told at all time points generally does not significantly differ from each other when accounting for characteristics of participants and family members.     

The effect of perceived and actual social support on the mental health of HIV-positive persons

The purpose of this paper is to compare the ways in which perceived and actual social support affect the mental health of gay men, straight or bisexual men, and women living with HIV/AIDS. Participants included 125 women and 232 men with an HIV-positive or AIDS diagnosis involved in three larger investigations of HIV, disclosure and mental health. Results suggest each sub-group experienced perceived social support as significantly predictive of better mental health while the effect of actual social support was minimal.     

Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study

Antiretroviral therapy (ART) for HIV is increasingly being introduced and utilized in diverse areas of the world. However, little research exists on adherence to ART in different cultural settings, particularly in developing countries such as India. This formative qualitative study examined barriers and facilitators of ART adherence among 60 (49 men, 11 women; 33 taking ART, 27 not currently taking ART) patients receiving HIV primary care at YRG CARE, a nongovernmental organization, in Chennai, India. The average participant reported becoming HIV infected through heterosexual transmission, was between 31 and 40 years old, had over ninth class standard education, was married, and generally had access to medical care; however, we obtained some qualitative data from various other risk categories. Trained ethnographers at the study site conducted in-depth interviews in the local language. These interviews were analyzed for content and ethnographic data. Almost all of the participants discussed the cost of ART as a barrier, with many reporting extended drug holidays, turning to family and/or friends, or taking drastic measures (i.e., selling family jewels, property) for financial assistance. Other barriers centered on privacy and stigma issues, such as disclosure of HIV inhibiting pill-taking and social support. Frequently discussed facilitators of adherence included perceived benefits of ART and proper adherence, perceptions about the consequences of nonadherence, and social support, if available. These data highlight the importance of reducing the cost of antiretroviral medications, involving family members in HIV care, and addressing privacy issues and stigma in counseling interventions in this setting.     

Reasons for HIV disclosure or nondisclosure to casual sexual partners.

The purpose of this study was to investigate reasons HIV-positive gay men give for disclosing or not disclosing their serostatus to their casual sexual partners. Participants were 78 HIV-positive gay men who were part of a larger HIV and disclosure project. A clear factor structure for disclosure emerged which suggests that issues of responsibility dominated men's decisions to disclose. No clear factor structure for nondisclosure emerged. Reasons for disclosure or nondisclosure to casual sexual partners were varied and this data could provide new insights for secondary prevention efforts. More research needs to be conducted to better understand salient issues in considering whether to disclose.     

Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India

The Indian government provides free antiretroviral treatment (ART) for people living with HIV. To assist in developing policies and programs to advance equity in ART access, we explored barriers to ART access among kothis (men who have sex with men [MSM] whose gender expression is feminine) and aravanis (transgender women, also known as hijras) living with HIV in Chennai. In the last quarter of 2007, we conducted six focus groups and four key-informant interviews. Data were explored using framework analysis to identify categories and derive themes. We identified barriers to ART access at the family/social-level, health care system-level, and individual-level; however, we found these barriers to be highly interrelated. The primary individual-level barrier was integrally linked to the family/social and health care levels: many kothis and aravanis feared serious adverse consequences if their HIV-positive status were revealed to others. Strong motivations to keep one's HIV-positive status and same-sex attraction secret were interconnected with sexual prejudice against MSM and transgenders, and HIV stigma prevalent in families, the health care system, and the larger society. HIV stigma was present within kothi and aravani communities as well. Consequences of disclosure, including rejection by family, eviction from home, social isolation, loss of subsistence income, and maltreatment (although improving) within the health care system, presented powerful disincentives to accessing ART. Given the multi-level barriers to ART access related to stigma and discrimination, interventions to facilitate ART uptake should address multiple constituencies: the general public, health care providers, and the kothi and aravani communities. India needs a national policy and action plan to address barriers to ART access at family/social, health care system, and individual levels for aravanis, kothis, other subgroups of MSM and other marginalized groups.     

Testing comprehensive models of disclosure of sexual orientation in HIV-positive Latino men who have sex with men (MSM)

Individuals who disclose their sexual orientation are more likely to also disclose their HIV status. Disclosure of HIV-serostatus is associated with better health outcomes. The goal of this study was to build and test comprehensive models of sexual orientation that included eight theory-informed predictors of disclosure to mothers, fathers, and closest friends in a sample of HIV-positive Latino gay and bisexual men. US acculturation, gender nonconformity to hegemonic masculinity in self-presentation, comfort with sexual orientation, gay community involvement, satisfaction with social support, sexual orientation and gender of the closest friend emerged as significant predictors of disclosure of sexual orientation.     

Methamphetamine-dependent gay men's disclosure of their HIV status to sexual partners

Disclosure of one's HIV status to a potential sexual partner has important HIV prevention implications. This paper qualitatively evaluates the social and sexual contexts that influence disclosure of HIV status among methamphetamine-dependent gay men enrolled in an outpatient drug treatment research program. As part of an open-ended, semi-structured interview, 34 HIV-positive and HIV-negative men discussed how, when, to whom and under what circumstances they reveal information about their HIV status. The four factors that influence participants' decision to disclose include: (1) an HIV-negative sexual partner's disclosure; (2) sexual venue (private versus public); (3) primary versus non-primary partner; and (4) the perceived risk of the sexual act. Sexual encounters among the men in this sample often occurred in public environments with non-primary partners, and involved use of illicit substances. In these social and sexual contexts, both HIV-positive and HIV-negative participants believed that it is HIV-negative rather than HIV-positive men who should initiate safer sex dialogue and safer sex practices. Findings are helpful in crafting HIV-prevention interventions targeting substance-using gay men whose sexual practices place them at high-risk for HIV-infection.     

To tell or not to tell: South African women's disclosure of HIV status during pregnancy

HIV-positive pregnant women often do not disclose their serostatus to their partners, family and friends, creating potential barriers to preventing sexual transmission to partners and mother-to-child transmission through breastfeeding. This research explores recently diagnosed HIV-positive pregnant women's reasons for disclosure and non-disclosure of serostatus to various members of their social networks, as well as the consequences of their disclosure. Data were collected through open-ended questions as part of a semi-structured interview with 293 recently diagnosed HIV-positive pregnant women recruited from antenatal clinics in two townships in Tshwane, South Africa. A content analysis of responses showed that women weighed fear of abandonment and discrimination against their desire to raise risk awareness and their need for support. Partners most often responded to disclosure with disbelief and shock, whereas parents frequently exhibited emotional distress, but were still supportive, as were other relatives and friends. The women subsequently experienced low levels of adverse consequences after disclosure. The results can assist healthcare providers in understanding the complexity of pregnant women's decisions to disclose to various members of their social networks and emphasize the need for continued counselling and support.     

HIV and Elevated Mental Health Problems: Diagnostic,Treatment, and Risk Patterns for Symptoms of Depression,Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV

People living with HIV (PLHIV) have almost double the risk of depression than the rest of the population, and depression and anxiety among PLHIV have been linked with greater disease progression and other physical health problems. Studies to date, however, have focused almost exclusively on depression or general mental health. Much less research has investigated predictors of anxiety and generalized stress among HIV-positive gay men. This paper reports findings from a national community-based sample of 357 HIV-positive Australians gay men aged 18 years and older. Participants reported elevated rates of depression, anxiety, and generalized stress symptoms. A significant proportion of men with elevated depression and anxiety symptoms were not receiving treatment or had not been diagnosed. Risk factors for elevated mental health concerns included experiences of internalized stigma and discrimination. Anxiety was also associated with lower T-cell CD4 counts. A key protective factor was access to social support. The type of support, in particular emotional support, was found to be more important than the source of support. Our findings suggest that greater emphasis is needed on mental health screening and the provision of emotional support for PLHIV.     

The impact of sexuality and race/ethnicity on HIV/AIDS risk among Asian and Pacific Island American (A/PIA) gay and bisexual men in Hawai'i.

The prevalence of HIV/AIDS in Asian and Pacific Island Americans (A/PIAs) has been relatively low in proportion to other racial/ethnic groups in the United States. However, HIV infection among A/PIA gay and bisexual men, and men who have sex with men has steadily increased in urban and other geographic areas with large Asian and Pacific Island populations. In this study of race/ethnicity and HIV risk among A/PIA gay and bisexual men in Hawai'i, respondents reported significant conflicts between loyalty to one's A/PIA family of origin and the enactment of individual sexual identity. Idealization of love and intimacy, intentional decisions to suspend safer sex practices, and Pacific Island cultural expressions of giving to others are all factors that may compromise HIV risk reduction in this population. Implications for HIV/AIDS prevention focus on integrating A/PIA, gay/bisexual, and "local" (born and raised in Hawai'i) identities in the development of multilevel interventions.