Communicating Social Support for Thai Men who have Sex with Men with HIV/AIDS

Abstract

This study aims to examine the communication of social support for Thai men who have sex with men (MSM) with HIV/AIDS. It is believed that this study can help the researcher and society better understand what sorts of social support promote health and safety among HIV/AIDS infected MSM facing stigma and discrimination related to both sexuality and disease. Also, it is to discover communicative patterns used to socially support those MSM living with HIV/AIDS and to know how these communication strategies are successfully employed. Social support has been studied extensively in the context of HIV/AIDS, but this work tends to ignore nuances of such support in the Thai culture in particular. These nuances, which involve gender/sexuality and privacy management, can complicate the stress-coping strategies and social constructionism in relation to health in the Thai cultural context. Additionally, as these factors in the present research are interrelated, the three research questions were developed: (1) How do sexuality, culture, and concerns about privacy management intertwine as Thai MSM with HIV/AIDS construct meaning in the experience of social support? (2) What patterns and processes of communication have Thai support networks employed to socially support MSM living with HIV/AIDS? (3) How successful are communication strategies used for social support? The research participants from the three HIV/AIDS organizations consisted of gay patients and healthcare staff infected with HIV and straight healthcare staff without HIV infection. All of them living in Bangkok and vicinity were over 18 years of age with different social support experiences. Observations of support groups (46 key informants including patients and healthcare providers at the two support organizations) and semi-structured interviews (23 care receivers and 14 staff members of the three support organizations) were carried out for a period of four months. Interpretive analysis of observations of support group meetings and in-depth interviews supplemented with the field notes recorded during the research process yielded fifteen themes that emerged from the four universal dimensions of social support: emotional, informational, instrumental, and positive reappraisal support. The findings revealed that the themes of emotional support reflected the importance of Theravada Buddhism and the collectivist culture in Thailand, which helped form sympathy, empathy, and privacy shared between support networks (i.e., family and friends) and Thai HIV/AIDS infected participants in contrast with the Western individualistic privacy. On the other hand, consistent with previous research on privacy and support groups in the Thai health context, the themes of informational support explained reliance on information mainly from self-help groups of HIV/AIDS infected MSM that possessed knowledge and experience with this disease. In addition, rather than separate functions of social support, it was seen in the study that one main theme of informational and emotional support can be integrated in order to promote commiseration so that the misery caused by social stigmatization among the Thai HIV/AIDS infected support group members can be reduced with use of Theravada Buddhist altruism. In this way, they were assured that other group members were also in the same or even worse situation, making one another feel validated. As for instrumental support, unlike other cultures focusing on trust relationship, direct assistance and embracing acceptance from support networks (e.g., siblings and relatives) in the Thai cultural context can strengthen interpersonal bonds that can foster physical and mental well-being. Finally, support for positive reappraisal involves not only spiritual care through use of Buddhism associated with parental and karmic issues, but also the use of Socratic questioning, which encourages HIV/AIDS infected individuals to have “sati” or Buddhist mindfulness for holistic healing, which is in contrast to Western mindfulness. The limitations of the study are discussed, and future research ideas are proposed to identify problems and improve the ways the research can be conducted to gain more valid research results with use of methodological approaches (e.g., observations and interviews). Further, theoretical implications involving other related theories (e.g., group identity and identity models) can be used so that this important issue of Thai MSM living with HIV/AIDS will be more extensively examined. Finally, regarding practical implications, research contributions can help Thai government, HIV/AIDS organizations, educational sectors, and not only healthcare providers but also the family or society to become aware of the true nature of Thai MSM with HIV/AIDS condition and then find some ways to enhance better understanding and effective communication for social support.