Gay Men with AIDS and Their Families of Origin: An Analysis of Social Support
Kadushin, Goldie, Health and Social Work
The impact of AIDS on the relationship between gay men and their families of origin is not well understood (Macklin, 1989). Whereas heterosexual men and women tend to seek help primarily from their families during the crisis of an illness (Croog, Lipson, & Levine, 1972; Finlayson, 1976; Weinert & Long, 1993), gay men with AIDS prefer partners and friends as sources of support (Hays, Catania, McKusick, & Coates, 1990; Hays, Chauncey, & Tobey, 1990). Social support has been established as an important resource in gay men's ability to cope with AIDS (Hays, Chauncey, et al., 1990; Turner, Hays, & Coates, 1993; Wolcott, Namir, Fawzy, Gottlieb, & Mitsuyasu, 1986; Zich & Temoschok, 1987). Therefore, social workers who provide services to gay men with AIDS should understand how the disease affects the family relationship so that supportive rather than stressful interactions can be encouraged.
This article examines the relationship between gay men with AIDS and their families by addressing the definition of social support, its influence on the physical and mental health of gay men with AIDS, the members of the support network, the roles of the family and siblings, and implications for practice and research. It should be noted that the following discussion is limited to the relationships between white gay men with AIDS and their families because, with the exception of one article (Mason, Marks, Dimoni, Ruiz, & Richardson, 1995), the literature on the relationship between African American and Hispanic gay men with AIDS and their families is nonexistent.
Green (1994) noted that there is little consensus about how to define social support. For this article a definition developed by House, Umberson, and Landis (1988) was used. According to House et al., social support can be subdivided into the concepts of social integration, social network, and relational content.
Social integration is the existence or quantity of social relationships, which includes the number of friends and relatives and the frequency of contact with these people. The number of active social ties determines one's degree of embeddedness in a social network, with social isolation constituting one extreme end point.
Social network is the structure that characterizes a set of relationships. Network density, reciprocity, gender composition, homogeneity, and durability are structural properties of a social network. The presence of women in a network, for example, might be regarded as an advantage in coping with stress because, on average, women are perceived as more supportive than men (Schwarzer, Dunkel-Schetter, & Kemeny, 1994).
Relational content is the function and nature of social relationships with various sources such as a spouse, a supervisor, friends, or relatives. It includes supportive interactions defined as the "positive potentially health-promoting or stress-buffering aspects of relationships" (House et al., 1988, p. 302). Functions of supportive interaction include providing instrumental support (for example, assisting with a problem), tangible support (for example, donating goods), informational support (for example, giving advice), and emotional support (for example, giving reassurance).
Two other forms of relational content are social regulation (or control) and social demands (or conflicts). Social regulation may promote health by encouraging healthful behaviors. For example, friends may encourage each other to exercise. However, social regulation can also damage health (for example, social pressure to drink). Social demands also can produce negative psychological and physical effects. For example, anxious and overprotective families can reduce the likelihood of returning to work among patients who have experienced a myocardial infarction. The outcomes of conflicted relationships can have greater negative effects on health than the positive ones resulting from helpful interactions (House et al. …