People living with HIV who report frequent loneliness are more likely to miss doses of their antiretroviral therapy, thus jeopardizing their health, according to a new study presented at the 24th International AIDS Conference (AIDS 2022) in Montreal.

The findings underline the importance of social intervention programs to combat isolation among people with HIV to optimize health outcomes, especially in the COVID-19 era.

In a study of almost 2,000 participants living with HIV, almost half felt moderately to extremely lonely over the course of follow-up, which ran from 2020 to 2021, the first year of the pandemic. There was a strong association between loneliness and treatment nonadherence after adjusting for demographic factors.

Certain groups of people living with HIV reported feeling lonely more often than others, including women, people with lower incomes and single, widowed and divorced people.

“Loneliness has become more known in the zeitgeist as a driver of negative health outcomes, so it was something we wanted to look at” said presenter Abigail Kroch, PhD, MPH, of the University of Toronto’s Dalla Lana School of Public Health. “We wanted to better understand things that are outside of those typical diagnostic tools for mental health and understand more of the holistic well-being of people living with HIV.”

Social isolation and loneliness can negatively impact physical and mental health, especially in older people. According to the Centers for Disease Control and Prevention, these feelings are associated with an increased likelihood of premature death, as well as heightened risk for dementia, heart disease and stroke. Another recent study found that untreated depression is also associated with lower antiretroviral adherence.

But surprisingly, younger people with HIV in this study felt more loneliness and were more likely to miss doses of their medications than their older counterparts, which runs contrary to most loneliness research. The researchers think this has to do with the compounding effects of the pandemic on feelings of social isolation for young people.

Kroch’s team analyzed data from 1,870 Canadians participating in the Ontario HIV Treatment Network Cohort Study, a longitudinal study of people living with HIV that has been running since 1996 at 15 clinics in Ontario.

The majority of participants were men (71%), with sizable female (22%) and non-binary (7%) representation; they were 52 years old on average. The racial/ethnic breakdown of the cohort was 60% white, 22% Black, 3% Indigenous and 16% from other groups.

The study looks at clinical data, serological and viral load test results, and responses to a lengthy questionnaire about psychosocial and behavioral health. The questionnaire is community governed, with participants reporting back to evaluate the survey and recommend improvements.

To evaluate loneliness, the questionnaire asked three questions to see how often participants felt they lacked companionship, felt left out and felt isolated from others on a three-point scale. Their scores were summed up to create a loneliness score ranging from 3 to 9. Respondents also reported whether they were currently taking antiretrovirals and the last time they missed a dose.

COVID-19 exacerbated loneliness for people living with HIV, which likely impacted the results since the study period included the height of pandemic-related lockdowns. The study is ongoing, and future analyses will look at the impact of the pandemic.

“We’re excited to look at [results] over time as this tool continues to be part of our study,” said Kroch.

Fortunately, public health interventions to reduce feelings of isolation among people living with HIV are underway, several of which were presented at AIDS 2022.

A growing number of initiatives are looking at peer support programs to help young people with HIV navigate their health and encourage adherence, including one study evaluating peer health navigators for young Black men who have sex with men. For older people living with HIV, researchers are looking at various social programs, including a “virtual village” to combat isolation during COVID-19.

“We need to think about how this fits into our overall toolbox for treating people living with HIV and supporting them,” said Kroch. “This is good evidence that outside of typical mental health supports, things like peer support programs can be really important for supporting people with HIV to maintain viral suppression.”

Click here to read the study abstract.

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