Helps associate in dire straits to start with (4)
I believe the answer is:
aids
'helps' is the definition.
('aid' can be a synonym of 'help')
'associate in dire straits to start with' is the wordplay.
'to start with' suggests taking the first letters.
The initial letters of 'associate in dire straits' is 'AIDS'.
(Other definitions for aids that I've seen before include "Helps with a dread disease" , "Said to be an international disease" , "Comes to the rescue" , "Condition following infection with HIV virus" , "Said to be a dread modern disease" .)