Social-environmental resiliencies protect against loneliness among HIV-Positive and HIV- negative older men who have sex with men: Results from the Multicenter AIDS Cohort Study (MACS)

Soc Sci Med. 2021 Mar;272:113711. doi: 10.1016/j.socscimed.2021.113711. Epub 2021 Jan 23.


Rationale: Loneliness is associated with negative health outcomes, such as cardiovascular disease, cognitive impairment, dementia, physical functional decline, depression, and increased mortality risk, among HIV- positive and HIV-negative older men who have sex with men (MSM). Given these negative health outcomes, it is imperative to identify factors that minimize loneliness in these vulnerable groups.

Objective: We sought to examine whether social-environmental resiliencies-defined as an individual's level of support, social bonding, and psychological sense of community among gay men-buffer against symptoms of loneliness.

Method: We analyzed longitudinal data from 1,255 older MSM with and without HIV infection, all of whom were enrolled in the Multicenter AIDS Cohort Study (MACS). Using longitudinal latent class analysis (LLCA), we identified three underlying classes (Social Connectors, Non-community Connectors, and Social Isolates) in the social environment of the sample. We assessed the prevalence of loneliness by these latent classes. By lagging social environmental factors over time, we were able to examine the temporal relationships between latent classes and subsequent loneliness.

Results: Consistent with our hypothesis, multivariate associations revealed that compared to Social Connectors with high levels of social support and social bonding and a strong perceived sense of community among gay men, Social Isolates (Prevalence Ratio (PR): 1.42; 95% CI: 1.08-1.88; p = 0.0120) and Non-community Connectors (PR: 1.34; 95% CI: 1.03-1.75; p = 0.0322) were more likely to experience loneliness after adjustment for covariates and baseline loneliness. There were no differences by HIV status.

Conclusions: These longitudinal data allowed us to make causal inferences related to the social environmental resiliencies lowering the odds of loneliness among HIV-positive and HIV-negative older MSM. Developing individual- and community-level tailored interventions for these populations by leveraging social environmental resiliencies is key to reducing loneliness and promoting health.

Keywords: HIV/AIDS; Loneliness; Older men who have sex with men; Resilience; Social bonding; Social cohesion; Social environment; Social support.