Social Connectedness and HIV: Strategies for Better Health
January 4, 2018
Troy arrived at my office looking fatigued and defeated. Having lived with HIV for nearly 14 years, he was now experiencing a severe downward spiral of depressive symptoms that caused him to sleep many hours each day. He rarely emerged from his apartment, describing his isolation as "far worse than ever before, even when I was diagnosed." Troy is an African-American man in his 50s who had come to Miami from his native Georgia to live openly in a gay community. His family at home knows nothing of his sexual orientation or HIV status, and because of issues of self-worth and avoidance of stigmatizing situations, he never developed a local network of support beyond one or two friends. Even with them, he rarely discusses his HIV status and, as he has aged, he has withdrawn even more, became increasingly distressed at feeling invisible in his own African-American gay community, and totally disconnected from the broader LGBT communities. As his isolation increased, Troy, for the first time, began to use methamphetamine to numb the hopelessness that he was now experiencing most days.
Depression and anxiety are strikingly common among persons living with HIV. This is due to a variety of factors, including stress about one's health and future, trauma, shame, stigma, and the physical effects of the virus itself. Yet, for both HIV and other health issues, evidence exists in the medical literature that provides distinct clues as to why certain individuals seem to thrive with better physical and emotional health while others do not. One of the more significant factors underlying such success is the ability of some individuals to successfully create and sustain social connectedness, defined simply as the quality and quantity of social relationships with others.
Social connectedness comprises several factors, including social integration, the overall level of involvement with informal networks (such as a spouse or close friends) and formal networks (institutions such as the church), which appear to be protective factors for improved health outcomes. In Troy's case, the absence of social integration was a central feature of his isolation. The more web-like and high quality these connections are, the better, because such networks of interrelationships mutually reinforce one another over time.
Studies with people living with HIV have found that direct health benefits derive from specific components of social connection, including individual resilience and a sense of control over one's social interactions, both of which increase the perception of available support and actually help secure social support in stressful times. A sense of social belonging or social capital, a term that describes the quantity and quality of one's network of relationships, is also significantly associated with HIV medication adherence, as well as overall functioning and satisfaction with quality of life.
Other factors such as gender also play a role. Men, for example, tend to mobilize support that is heavily focused on their partners or spouses, whereas women are much more likely to rely on a child, close relative, or a friend as their confidant. Consequently, widowhood is consistently more damaging to the physical and mental health of men than women. Education is important, as well. Educated adults typically have a larger number of close relationships and may experience less overall stress in their interpersonal relationships, leading to the experience of less isolation.
While evidence concerning the overall health benefits of social connection is beyond doubt, specific strategies that promote greater connectivity among people living with HIV have not received as much attention from researchers. Some strategies, however, can improve social connection. Here they are:
As medications for HIV improve longevity, other psychosocial factors such as social isolation have greater negative impact on the overall well-being of people living with HIV. The health benefits of improved social connectedness are well documented. Whether you utilize the strategies listed here or get ideas from friends, take the time and care to nurture your social networks. You will be well rewarded.
David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida. He is the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery.
This article was provided by TheBody.
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