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

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.

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 2-way fixed-effects regression to account for unobserved individual and time-specific variations.

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 nonhousehold members.

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.