Perceptions of Social Support and Psychological Adaptation to Sexually Acquired HIV among White and African American Men

Article excerpt

In recent studies of the psychosocial coping activities of HIV-infected individuals, the presence and use of social support have gained importance as an indispensable component of psychological care (Flynn, Smith, Bradbeer, & Watley, 1991; Lackner, Joseph, Ostrow, Kessler, & O'Brien, 1991; Ostrow, Fraser, et al., 1991; Reisbeck, Buchta, Hutner, Oliveri, & Schneider, 1991). In particular, much has been learned about the mental health and psychosocial impacts of the human immunodeficiency virus (HIV) epidemic among self-identified gay men, primarily those residing in epicenters of acquired immune deficiency syndrome (AIDS) such as San Francisco and New York.

However, more information is needed regarding groups commonly ignored by current research. Few studies exist, for example, on the mental health of men who have sex with men but do not self-identify as gay or bisexual, of men of color who experience an increase in psychosocial pressures without a corresponding increase in community-based resources, and on the much broader socioeconomic distribution of men at risk of infection through homosexual activities (Mays & Cochran, 1987). For instance, one study of HIV-infected gay white men found relationships among active-behavioral coping, lower mood disturbance, satisfaction with social support, and higher self-esteem (Namir, Wolcott, & Fawzy, 1987). In another study of 29 HIV-infected gay white men, however, active-behavioral coping was significantly related to greater mood disturbance and lower social support (Wolf et al., 1991). Finally, Hays, Chauncey, and Tobey (1990) found friends and fellow persons with AIDS to be the greatest source of social support for a sample of 24 gay white men, with size of the social support network correlated with mental health measures.

The assumption that the relationships between social support and perceptions of psychosocial and mental health functioning in the presence of AIDS are similar for African American and white men is unwise, problematic, and difficult to substantiate for three reasons. First, ethnic distinctions in help-seeking for mental health problems and physical problems are well documented (for example, Broman, 1987; Dressier, 1985; Sussman, Robins, & Earls, 1987). Second, African Americans and white people differ in the relative use of formal and informal social support systems (Antonucci & Jackson, 1990; Broman, 1987; Neighbors & Jackson, 1987).

Third, African American men who have sex with men face issues that may be qualitatively different from those of their white counterparts, including differential expressions of homophobia in certain African American subpopulations (Friedman, Sotheran, & Abdul-Quader, 1987; Loiacano, 1989). Although this article will provide brief examples to develop this point, we refer the reader to Dalton's (1989) classic article for a fascinating and more extended discussion.

African American men who have sex with men have minimal interaction with existing social support networks within the gay white male community (Friedman et al., 1987). Research suggests that this population faces isolation and alienation stemming from real or perceived racism in traditional gay community organizations and depends more heavily on support systems oriented outside the white gay community, particularly family support systems (Icard, 1986; Mays & Cochran, 1987). However, many times family support for African American men is compromised; families may rally around when the physical illnesses of the person become manifest but criticize his sexual orientation and the route of transmission (Icard, Schilling, El-Bassel, & Young, 1992). The reliance of African American men with HIV on informal social support systems that hold negative or stigmatizing attitudes toward HIV infection, sexual orientation, and homosexual or bisexual behavior may negatively affect their psychosocial and mental health status (Dalton, 1989; Icard et al. …