The Strength of Long-Distance Ties for Aging Healthy with HIV: The Case of Rural South Africa.

Objectives: In lower-income settings with limited government-funded care, personal social networks are often the primary means by which older persons access resources and support. We tested the association between long-distance ties-ties that span greater geographical and network distances-and HIV treatment outcomes in a rural South African community with one of the largest aging populations with HIV.

Methods: We used data from the "Health and Aging in Africa: Longitudinal Studies in South Africa" (HAALSI), a population-based panel study of adults aged ≥ 40 years. We examined how the proximity of social contacts, defined by geographic and network spaces, correlated with viral suppression outcomes among older people living with HIV, using random-effects regression with survey fixed effects to assess individual heterogeneity, and two-way fixed-effects regression to account for unobserved individual and time-specific variations.

Results: Respondents who maintained social relationships in distant South African regions had better-managed HIV viral suppression than those without such relationships. Long-distance ties that are strong, defined by kinship and weekly communication, appeared most beneficial. These distant relationships were positively associated with better-managed viral suppression among respondents who lived alone, had less education, and were unemployed. These contacts were characterized by similarly-aged non-household members.

Discussion: The observed patterns highlight an important but less-discussed social network channel in older adults' personal relationships. Our findings emphasize that long-distance ties-personal relationships spanning greater geographic distances-can be as important as close proximity ties for healthy aging with HIV, particularly among those living alone and with fewer personal resources.