Family Social Support Mediates the Relationship Between the COVID-19 Pandemic and Psychosocial well-being in a Cohort of Young South Africans Newly Diagnosed with HIV

Poor psychosocial well-being, including depression, anxiety, low self-esteem, and high anticipated stigma, complicates young South Africans' engagement with HIV care. During the COVID-19 pandemic, the psychosocial well-being of young South Africans with HIV may have been impacted by changing levels of social support. This analysis sought to examine whether social support mediates the relationship between the pandemic and psychosocial well-being in young South Africans with HIV. This secondary analysis compared baseline data from two cohorts of young people ages 18-24 who tested HIV positive either before or during South Africa's COVID-19 State of Disaster. Baseline sociodemographic, social support-related, and psychosocial data were analyzed using linear regression and mediation analyses. We found that self-esteem was higher (χ² = 9.955, p < 0.01) and anticipated stigma (χ² = 22.756, p < 0.001) was lower in the cohort recruited during the pandemic. Perceived family social support was higher in the cohort recruited during the COVID-19 pandemic (χ² = 38.69, p < 0.001). Family social support partially mediated the relationship between study cohort and self-esteem (Sobel z=-3.04, p = 0.002), family- (Sobel z=-4.06, p < 0.001) and community-type (Sobel z =-3.44, p < 0.001) anticipated stigma, and depressive symptoms (Sobel z =-2.80, p = 0.005). Overall, compared to young people diagnosed with HIV before the pandemic, young people diagnosed during the pandemic reported higher self-esteem and lower anticipated stigma, an effect mediated by higher levels of family social support. Our findings add to the literature examining young people's psychosocial well-being during the COVID-19 pandemic and suggests that improvements in family support may have broadly positive effects on multiple indicators of psychosocial well-being.