The relationship between social support and the health of HIV-positive caregivers of children: A review of the empirical literature

Abstract

A wealth of global literature suggests that social support can play an important protective role for the well-being of caregivers of children and the children in their care. In Southern Africa, where the caregiving burden is intensifying and the prevalence of HIV and other physical and mental health disorders is elevated, strengthening social support resources may be the key to more effective carer and child health interventions. This may be especially true for HIV-positive and/or AIDS-ill carers, who face heightened caregiving challenges and health risks. This review aims to consolidate the existing international literature in this area by summarizing methodologies and empirical findings of published and unpublished studies that quantitatively assess the association between one or more measurable dimension of social support and one or more measurable physical or mental health outcome, among HIV-positive and/or AIDS-ill adult caregivers of children. Limitations, strengths and key findings of the 15 identified studies are discussed, as are gaps and implications for future research. Overall, study findings highlight a positive relationship between social support and health, particularly mental health, reinforcing the importance of social support as an integral element of mental health interventions for HIV-positive caregivers of children. The absence of research in Southern Africa, and other parts of the developing world most affected by the HIV/AIDS epidemic, highlights the need for future investigation in these contexts. Recommendations for further research include larger and more representative studies; longitudinal studies; studies with caregivers of non-biological children; and research linking caregiver social support to parenting and child outcomes. Moreover, mixed methodology approaches would be useful to better understand the sources and types of social support most relevant for health outcomes in this specific population, as well as the mechanisms through which this support may be affecting health.

Keywords:

• social support
• caregivers of children
• mental health
• physical health
• HIV and AIDS

Notes

1. The 2009 estimate for the total number of orphans in sub-Saharan Africa, as a result of HIV/AIDS and other causes, is approximately 56 million. This figure was taken from the UNICEF “State of the World's Children 2011” report, available at: http://www.unicef.org/sowc2011/pdfs/Table%204%20HIVAIDS_12082010.pdf.

2. While we covered a large number of individual databases and were as thorough as possible in our selection of databases to be searched, we recognize that there may be other relevant databases for the current topic that we could not access as our institutions do not subscribe to them. Examples include EMBASE and the British Nursing Index.

3. Sharts-Hopko et al. (1996) found that the perceived cost of social support (as measured by the short form of the Interpersonal Relationship Inventory; Tilden, 1991) was inversely associated with psychological distress among HIV-positive mothers; however, this has not been included among reported negative associations in the section “Results”, since it is a distinct concept from extent or level of social support and therefore may be confusing. A possible explanation offered by the authors is that the ability to recognize the costs of social support may be an indicator of coping or at least of a lesser degree of neediness (Sharts-Hopko et al., 1996). In addition, Leslie et al. (2002) found greater social support, as mediated through coping strategies, to have an indirect positive effect on health-care satisfaction and an indirect negative effect on substance use. Similarly these findings have not been reported amongst those relevant to the review as they measure different constructs to health status, namely (1) satisfaction with health care, which may depend in part on existing care facilities and (2) substance abuse, which is a health risk behaviour.

4. Only one study (Klein et al., 2000) conducted comparative analysis with a control group of HIV-negative caregivers with similar demographic characteristics, and worked with longitudinal data from two assessments conducted over 12–14 months. Differences in results regarding the association between types of socio-emotional support and psychosocial functioning among HIV-positive versus HIV-negative caregivers were tested in the regression models using interaction terms (HIV status × type of support). No significant differences were found. However, the study showed that HIV-infected women reported lower levels of emotional support from the child and from neighbours and friends, as well as higher levels of psychological distress. Longitudinal analysis highlighted the importance of socio-emotional support from friends and neighbours as a health resource; that is, changes in the level of this support were associated with changes in levels of psychological distress.