title: Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study.
abstract: Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients  = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.
authors.affiliation: a Department of Infectious Diseases and Microbiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.|b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: M Reuel
authors.initials: MR
authors.lastname: Friedman
authors.affiliation: b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.|c Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Robert W S
authors.initials: RW
authors.lastname: Coulter
authors.affiliation: a Department of Infectious Diseases and Microbiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.|b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Silvestre
authors.affiliation: b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.|c Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
authors.affiliation: d Department of Medical Social Sciences , Northwestern University , Chicago , IL , USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Teplin
authors.affiliation: e Department of Family Medicine , David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , CA , USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Shoptaw
authors.affiliation: f Department of International Health , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: g Department of Medicine , Georgetown University Medical Center , Washington , DC , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000523:psychology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; Men who have sex with men; psychosocial health conditions; social support; viral load