Social support and delays seeking care after HIV diagnosis, North Carolina, 2000–2006

Abstract

Many adults in the USA enter primary care late in the course of HIV infection, countering the clinical benefits of timely HIV services and missing opportunities for risk reduction. Our objective was to determine if perceived social support was associated with delay entering care after an HIV diagnosis. Two hundred and sixteen patients receiving primary care at a large, university-based HIV outpatient clinic in North Carolina were included in the study. Dimensions of functional social support (emotional/informational, tangible, affectionate, and positive social interaction) were quantified with a modified Medical Outcomes Study Social Support Scale and included in proportional hazards models to determine their effect on delays seeking care. The median delay between diagnosis and entry to primary care was 5.9 months. Levels of social support were high but only positive social interaction was moderately associated with delayed presentation in adjusted models. The effect of low perceived positive social interaction on the time to initiation of primary care differed by history of alcoholism (no history of alcoholism, hazard ratio (HR): 1.43, 95% confidence interval (CI): 0.88, 2.34; history of alcoholism, HR: 0.71, 95% CI: 0.40, 1.28). Ensuring timely access to HIV care remains a challenge in the southeastern USA. Affectionate, tangible, and emotional/informational social support were not associated with the time from diagnosis to care. The presence of positive social interaction may be an important factor influencing care-seeking behavior after diagnosis.

Keywords:

• HIV infection
• social support
• time factors
• delivery of health care
• southeastern USA

Acknowledgements

The authors are grateful to all of the research assistants who conducted interviews and to the patients who participated in the study. We are also appreciative of Bill Jones at NC DHHS for assistance with matching patients to state records, Sharon Christ at the Odum Institute for her guidance on confirmatory factor analysis, and Sonia Napravnik and Brant Stalzer for oversight and management of data collection. This work was supported in part by a grant from the University of North Carolina Center for AIDS Research (P30 AI50410) and the US Centers for Disease Control and Prevention Grant for Public Health Dissertations (1R36PS000848-01). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention.