"Alone, there is nobody": A qualitative study of the lived experience of loneliness in older men living with HIV

Experiences of Loneliness Among Gay Men: A Systematic Review and Meta-Synthesis

Loneliness is a significant social and public health issue, particularly among gay men who often face unique challenges shaped by their social identities and minority status. These challenges often exacerbate feelings of isolation and exclusion, yet the specific ways in which gay men experience loneliness remain underexplored. This study aimed to offer insights for health professionals and policymakers via a systematic review and meta-synthesis. A comprehensive literature search was conducted in May 2024 across five major databases and gray literature to identify appropriate qualitative studies (i.e. if they focused on the experiences of loneliness among gay men, were qualitatively designed, and included participants over the age of 18). 72 studies, encompassing approximately 1335 participants were analyzed. Guided by Intersectionality Theory and the Minority Stress Model, data analysis generated three categories that impacted gay men's experiences of loneliness. (1) external influences of discrimination (lack of support systems, cultural standards, geographic location), (2) internal conflicts (internalized homophobia, concealment, fear of rejection), and (3) coping mechanisms (sex, substance use, social life and connections, embracing solitude). The findings highlight the complex interplay between external pressures and internal struggles, as well as how intersecting identities shape the diverse experience of loneliness among gay men.

The role of metacognitive beliefs in generalised anxiety disorder in men who have sex with men living with HIV in Nigeria

Men who have sex with men (MSM) living with HIV tend to experience a range of mental health issues, in particular generalised anxiety disorder (GAD), often caused and maintained by psychosocial variables including HIV stigma, discrimination, self-esteem issues, substance abuse and loneliness. This is particularly problematic in countries like Nigeria where same sex activity is illegal and can result in up to 14 years imprisonment. An important psychological variable that may contribute to the experience of GAD are metacognitive beliefs. Participants (N = 311) completed measures to examine the relationship between these variables. Results indicated that metacognition was associated with, and significantly predicted, GAD in this population. Moderation analysis showed that the effect of HIV stigma on GAD was explained by the proposed interaction with metacognition. Findings suggest that metacognition may be an important variable in explaining GAD symptoms in MSM living with HIV in Nigeria.

The UN Decade of Healthy Ageing (2021-30) for people living with HIV

The Decade of Healthy Ageing (2021-30; the Decade), proclaimed by the UN in 2020, is a global initiative aimed at fostering collaborations to transform the world into a better place to live and grow older in. The Decade presents a positive vision of ageing, discarding the stereotypes of diseases and disabilities and promoting focus on capacities and abilities. This approach will help to foster a more inclusive world and, consequently, care systems, which value the dignity of each individual. Although the initiative represents a resource for the global population, the Decade also provides a unique opportunity for the large community of people living with HIV in terms of increased visibility and long-term solutions for their specific ageing-related health issues. This Personal View focuses on the relevance of the Decade in improving the lives of people in the HIV community, the rationale for a stronger engagement of people living with HIV in this initiative, and the potential to reduce global disparities between the HIV community and the general population and among different global regions.

Heavy alcohol use and the HIV care continuum in Kenya: a population-based study

Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15-64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8-11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14-6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25-6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85-5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum.

Sociodemographic associated factors with non-disclosure of HIV sero-status to sexual partners in Maputo, Mozambique

The HIV prevalence in Maputo city is 16.2%. There is a lack of data describing associated factors with disclosure or non-disclosure of HIV-positive sero-status to sexual partners. This analysis describes associated factors of non-disclosure of HIV sero-status to sexual partners among people living with HIV (PLHIV) participating in a serostatus disclosure support program at three health facilities in Maputo, Mozambique. We used a cross-sectional design of PLHIV aged over 18 years. Datas were collected between December 2019 and September 2020. Univariate and multivariable logistic regression models were used to evaluate factors associated of non-disclosure of HIV sero-status. A total of 377 patients were enrolled in the HIV sero-status disclosure Program. Of these, nearly two-thirds (61.5%) were women, 52.9% had completed secondary school, 47.7% were 25-34 years old, 50.9% had informal employment with low income, and 73.2% were married. Univariate logistic regression model showed greater odds of non-disclosure among patients who had an employment contract with a maximum wage (Crude Odds Ratio [cOR] 2.02, 95% confidence interval [CI] 1.15-3.55, p = 0.015); were single (cOR 3.85, 95% CI 2.22-6.69, p < 0.001); were living with parents (cOR 2.30, 95% CI 1.07-4.93, p = 0.033); received financial support for their monthly household expenses from parents or a close relative (cOR 7.15, 95% CI 2.19-23.36, p = 0.001); or brought a parent/close relative and/or a friend as a confidant during HIV care(cOR 3.17, 95% CI 1.74-5.76, p < 0.001; and cOR 5.97, 95% CI 1.57-22.66, p = 0.009, respectively). Multivariable logistic regression model showed: from parents/close relative and from partner (Adjusted Odds Ratio [aOR] 8.19, 95% CI 1.44-46.46, p = 0.018; and aOR 4.34, 95% CI 1.05-17.17, p = 0.043), respectively); in those who brought a parent/close relative and/or a friend as a confidant during HIV care (aOR 8.86, 95% CI 2.16-36.31, p = 0.002; and 195 aOR 21.68, 95% CI 3.02-155.87, p = 0.002, respectively). Non-disclosure of serostatus is a critical issue for HIV care and treatment programs, given that non-disclosure of HIV serostatus increases risk of HIV transmission. Understanding the factors associated with non-disclosure is crucial for designing strategies to address these factors and end the HIV epidemic by 2030. Our findings suggest that HIV serostatus disclosure programs might target the sociodemographic factors strongly associated with non-disclosure.

Telehealth access and experiences of older adults with HIV during the COVID-19 pandemic: Lessons for the future

BACKGROUND

Telehealth services are proposed to improve access and retention to care for people with HIV (PWH). Yet the rapid uptake of telehealth services during the COVID-19 pandemic created equity concerns, especially for already vulnerable populations. Older PWH may face a combination of barriers to telehealth but also stand to benefit given social isolation and the need for multimorbidity management. Few studies have focused on this population, and we aimed to assess the telehealth capability and experiences of older PWH at an urban HIV clinic.

METHODS

We did this in two ways: (1) we contacted PWH aged ≥65 via telephone about telehealth capabilities and (2) we conducted focus groups with older PWH who transitioned from in-person to virtual classes affiliated with the clinic.

RESULTS

Among 179 PWH aged ≥65, 80 answered the telehealth questions. Among those who answered, 91% were male with a mean age of 69 (SD 3.0), and 55% were White. One-third did not have internet access or an email address. A total of 65% had at least one telehealth-capable device but 12.5% of respondents with a device did not know how to use it. Thirteen older PWH participated in focus groups with a mean age of 64 (SD 6.9) and 44% female. Themes were grouped into benefits (social/emotional connection and convenience) and challenges (technological barriers and missed in-person experience).

CONCLUSION

Participants preferred in-person classes but felt telehealth was a good alternative for mitigating isolation. Telehealth gave those with mobility and transportation issues improved access to supportive services. As the COVID-19 public health emergency ends, hybrid options should be considered to improve access for older PWH and address social isolation. Ensuring equitable access to devices and digital literacy training will be critical to ensure services can be utilized.