Personal support network typologies as predictors of current sexual and mental health risks in rural South African youth

IntroductionYouth in rural South Africa face substantial challenges during the transition to adulthood, including high risk of sexually transmitted infections and poor mental health. Social support is a known protective factor for these outcomes globally, yet evidence for how multiple aspects of social networks shape these outcomes among African youth is lacking. We therefore aimed to, first, identify typologies of personal support networks among young people in rural KwaZulu-Natal, and second assess their associations with sexual and mental health outcomes.MethodsWe analysed baseline data from Sixhumene, a cohort of 946 participants aged 16–30 from three rural communities. We derived network typologies by entering structural, compositional, and support level characteristics into a hierarchical cluster analysis. We then used regression analysis adjusted for socio-demographic covariates to estimate associations between typologies and eight mental and sexual health outcomes: hope; symptoms of common mental disorders; sexual health knowledge and misinformation; capability to have safer sex; sexual behaviour; and HIV and HSV 2 serostatus.ResultsFive distinct network types emerged: local friend oriented; diverse with limited support; disconnected; diverse well supported; and local family oriented. Network types differed most strongly by levels and distribution of support rather than relational composition. Youth with disconnected networks had the poorest hope, knowledge, and capability outcomes and the highest HSV 2 and HIV prevalence. In contrast, support rich networks (diverse well supported and local family oriented) had better mental health, greater prevention knowledge, and stronger safer sex capability. Diverse networks with limited support performed worse on several outcomes despite their larger size.ConclusionSupport network typologies capture meaningful variation in social environments beyond socio-demographics. Individuals with low support, disconnected networks represent a high risk subgroup warranting targeted interventions that expand social worlds and strengthen supportive ties to improve sexual and mental health during the transition to adulthood in resource constrained settings.