HIV-disclosure, social support, and depression in African American women with HIV disease living in the rural Southeastern United States

Rural African American women with HIV disease are at high risk of depression. Conservative values and social norms in rural areas discourage HIV-infected women from disclosing their HIV-positive status and isolate them from social support which is critical in minimizing psychological stress. This study explored the relationships between HIV-disclosure, social support, and depression among African American women with HIV disease living in the rural Southeastern United States. Baseline data from a 5-year longitudinal study were used to conduct this secondary analysis. Between March 2004 and January 2008, 340 African American women, recruited from rural areas of South Carolina, North Carolina, and Alabama, completed baseline interviews. In addition to depression and HIV-disclosure, three aspects of social support (availability of different types of support, sources of support, and satisfaction with support) were measured. Despite reporting high levels of depressive symptoms, nearly 40% of the participants had never been diagnosed with depression. Perceived availability of support (p<.0001), sources of support (p=.03), satisfaction with support (p=.003), and HIV-disclosure (p=.05) were all significantly and inversely correlated with depression. Perceived availability of support and satisfaction with support were found to mediate the relationship between HIV-disclosure and depression. The findings have implications in designing programs to support rural African-American women with HIV disease in disclosing their HIV-positive status to appropriate persons in their social networks in order to increase social support. Additionally, efforts must be focused on early diagnosis and treatment of depression among these women. This, in long term, may improve their quality of life.