Disclosure avoidance mediates the relationship between social networks and social support among HIV+ individuals

Background. Social support provided by social network members is critical to the well-being of HIV+ women of color. However, network members may be unaware of HIV status due to HIV disclosure avoidance. Objective. Using data from the Guide to Healing project, we estimate both direct and indirect effects to evaluate how disclosure avoidance mediates the relationship between social networks and reported social support. Methods. Data were collected from ~150 HIV-positive women of color patients at the University of North Carolina's Infectious Disease clinic (July-December, 2011). General Social Survey questions were modified to elicit egocentric network membership and member characteristics. Interviewers also asked validated questions related to social support, disclosure avoidance and demographics. Measures of network exposure, size, support-provision and disclosure avoidance were constructed. We derived risk differences (RDs) from standard linear regression models, which generated beta coefficients and 95% confidence intervals for the direct and indirect effects related to disclosure avoidance. Results. Women were equally distributed across education categories (less than high school (HS), HS, more than HS) and 65% were <50 years old. About 10% were in non-permanent housing and the majority (72%) was unemployed. In models adjusted for age, education, insurance and employment, both more network ties and having ties who know one's HIV status were associated with higher values of treatment-specific social support. Disclosure avoidance was associated with lower social support. Conclusion. Social networks are understood to be an important source of social support for HIV+ women, but perceived social support is mediated through HIV disclosure.