AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #286 - Social ties and HIV disease progression among the homeless and marginally housed
Authors: Presenting Author: Dr Alexander Tsai - Harvard School of Public Health
Additional Authors: Dr. Ichiro Kawachi, Dr. David Bangsberg,
Aim: To estimate the effects of social ties, and changes in social ties, on HIV outcomes among homeless and marginally housed HIV+ men and women.
Method / Issue: Data for this analysis were obtained from the Research on Access to Care in the Homeless (REACH) study, an observational prospective cohort of homeless and marginally housed adults living with HIV in San Francisco, California. Study participants were recruited from homeless shelters, free-lunch programs, public HIV clinics, and low-income, single-room occupancy hotels. Data collection occurred every 3 months via blood draws and structured interviews. The primary outcome of interest was CD4+ T-lymphocyte cell count. The primary covariate of interest was an index of social ties, constructed as the linear sum of 4 questions about the presence of a confidant, emotional social support, instrumental social support, and social network size (Gielen et al., Soc Sci Med 2001;52:315-322). We used random effects and fixed effects regression models to estimate the association between social ties and changes in social ties, respectively, and CD4+ count. Estimates were adjusted for time, baseline age, race, homelessness, alcohol use, illicit drug use, Beck Depression Inventory-II score, SF-36 PCS and MCS scores, use of HIV antiretroviral therapy, and poor self-reported overall health. Separate regression models were fit for men and women.
Results / Comments: 144 men and 407 women were followed for a median of 3 years (range, 0.3-6 years). At baseline, 72% reported having a confidant, 68% reported having someone s/he could turn to for money, 63% reported having someone s/he could turn to for shelter, and 75% reported having more than 2 close friends. The social ties index demonstrated excellent internal reliability (alpha=0.74), and factor analysis confirmed the presence of a single factor. Among women, each one-point difference in the social ties index was associated with a 5.4 greater CD4+ count (95% CI, 0.8-10.1). When converted to standardized coefficients, the effect of social ties was 4 times smaller than the effect of being on HIV antiretroviral therapy. Among men, the estimated coefficient was not statistically significant (b=-2.1; 95% CI, -10.8 to 6.6). In fixed effects analyses among women, a one-point increase in the social ties index (from one 3-month period to the next) was associated with a 6.3 increase in CD4+ count (95% CI, 1.8-10.8). Among men, the fixed effects estimate was not statistically significant (b=-2.9; 95% CI, -11.6 to 5.8).
Discussion: Social ties had a statistically significant protective effect against HIV disease progress. This effect persisted after adjusting for known confounders and mediators, including alcohol and drug use, depression symptom severity, physical health status, and being on HIV antiretroviral therapy. In contrast to the literature from social epidemiology, the effect of social ties was statistically significant only among women. Interventions to strengthen social ties among homeless and marginally housed persons living with HIV/AIDS may improve health outcomes.
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