Social support networks and medical service use among HIV-positive injection drug users: implications to intervention

Abstract

The study used network analysis to identify forms and sources of social support associated with a medical services use among a medically underserved population living with HIV/AIDS. Participants were African American former or current injection drug users (n=295; 34% female, 45% current drug users and 17% AIDS diagnosed). Outcomes were access to the same medical provider, use of outpatient services and emergency room (ER) use with or without subsequent hospitalization. Controlling for AIDS diagnosis, insurance, current drug use and gender, access to the same medical care provider was associated with more females in one's support network and more network sources of emotional support, financial support and instrumental assistance. Adjusting for confounders, outpatient service use was associated with more female support network members and more sources of emotional support. Controlling for participants' drug use and insurance, sub-optimal emergency department use was associated with greater number of active drug users in one's support network. Contrary to other study findings, having a supportive sex partner was associated with lower access to medical care, and kin support was not associated with medical service use. Results indicate that specific sources and forms of social support had differential influences on the sample's utilization of medical services. The findings suggest that promoting HIV-positive African American injection drug users' support network functioning may help improve HIV medical services utilization among this medically underserved population.

Barriers to HIV Care for Women of Color Living in the Southeastern US Are Associated with Physical Symptoms, Social Environment, and Self-Determination

“…[17][18][19] However, this effect was not observed among our sample. Rather, general social support in the form of emotional and practical support was associated with fewer reported barriers to care, confirming that social support may buffer barriers to care.…”

“…15, 16 The presence of general social support from formal and informal networks has been shown to contribute to engagement in HIV care, particularly among AAs. [17][18][19] Social expectation, norms, and pressure from one's peer network may facilitate engaging in HIV care. 20 Psychological aspects of the patient, such as self-determination, may also play an important role in engaging in HIV care among WOC.…”

“…Rather, general social support in the form of emotional and practical support was associated with fewer reported barriers to care, confirming that social support may buffer barriers to care. [17][18][19]42 The difference in these two findings may be explained by the heterogeneous effects of social networks on access to care. In a prior study on HIV-positive AfricanAmerican women, 19 social support from other women, and emotional support, were associated with outpatient service use, whereas instrumental support in the form of direct financial and physical assistance was not.…”

“…[17][18][19]42 The difference in these two findings may be explained by the heterogeneous effects of social networks on access to care. In a prior study on HIV-positive AfricanAmerican women, 19 social support from other women, and emotional support, were associated with outpatient service use, whereas instrumental support in the form of direct financial and physical assistance was not. A recent pilot study suggests that peer-support among HIV positive AfricanAmerican women reduces stigma 43 and may have implications for engagement in HIV care.…”

Social Capital and Health Care Access

“…For example, more strong-tie, non-disperse networks (i.e., those where most members are immediate family members or relatives) have been found to be associated with under-utilization of prenatal care (St Clair, Smeriglio, Alexander, & Celentano, 1989). And for HIV-positive injection drug users, networks with more females, more emotional support, and fewer drug users have been related to having a regular source of care, outpatient service use, and optimal emergency department use (Knowlton, Hua, & Latkin, 2005).…”