Group Interventions Ease Loneliness in Older Adults With HIV

Tailoring existing evidence-based loneliness intervention according to urban or rural settings may more effectively reduce loneliness in adults living with HIV, based on a comparison of programs in urban and rural settings. The comparison was presented in a poster at the Association of Nurses in AIDS Care 2024 Annual Meeting.

“Loneliness is a negative contributor to morbidity and mortality in all aging people, and a large percentage of people living with HIV are greater than 50 years of age,” said lead author Jennifer Sobolik, MSN, of Complete Health, Rapid City, South Dakota, in an interview. 

Sobolik and coauthor Justin Alves, RN, of Boston University School of Medicine, Boston, analyzed a loneliness intervention program for people aging with HIV in an urban and rural setting to determine modifications for effectiveness. 

“The impacts of loneliness may be amplified in people aging with HIV who have experienced significant loneliness secondary to stigma, isolation, and marginalization,” Sobolik told Medscape Medical News. “Nurses have an opportunity to design interventions to combat loneliness and part of comprehensive HIV-related care, so it was important for us to explore which components participants found most beneficial and compare interventions in rural and urban settings,” she explained.

Sobolik and Alves reviewed an urban program that served 14 patients and a rural program that served 15 patients. Demographics were similar between the groups; the average number of years of living with HIV in the urban and rural groups was 26 and 23, respectively. All but one patient in the urban group and all patients in the rural group were men, and 50% and 60% of the urban and rural groups were White individuals. The average age of the participants in the urban and rural groups was 56 years and 57 years, respectively, and approximately 29% and 60%, respectively, were gay. 

The groups had similar themes overall, including whole health, non-HIV topics for group discussion, and improved attendance in the program with provision of supplies to address social determinants of health. The need for accessibility for those with physical limitations was another theme in both settings.

Urban Vs Rural

However, some distinctions emerged in the themes of discussion. Participants in the urban group preferred an in-home or in-building location, and were more likely to request personal invitations or an accompaniment to the group location. The urban participants also expressed interest in free group activities, such as trips to the zoo or library, Sobolik noted. Top discussion topics in the urban group included end-of-life care, sexual health, loneliness, immunizations, and conflict resolution.

Rural-specific themes included a preference for grouping by age, private group location, and outdoor activities when weather permitted. Top rural discussion topics included loneliness, advocacy, immunizations, osteoporosis, and senior community assistance.

“As nurses who have cared for people living with HIV for many years, we were not surprised to find that people desire connection with others who share their lived experience,” Sobolik told Medscape Medical News. “We were interested to discover the impacts that loneliness has on overall health, and how greatly loneliness can be lessened by simple interventions like small group gatherings and shared spaces,” she said. 

Sobolik and Alves found that rural residents did not view geographic isolation as a cause of loneliness; instead, they felt that loneliness was caused by stigma and lack of connection. Both groups had increased participation when food and supplies were offered at gatherings, which would require funding to continue, they noted. 

The findings were limited by several factors including the lack of evidence-based loneliness screening tools specific to HIV, HIV-related stigma in communities that prevented participation in the program, the review of only two programs, and the participants’ refusal to complete formal surveys, the researchers noted. 

However, “the results suggest that interventions for individuals aging with HIV should be tailored to fit the needs of specific populations with awareness that needs may vary based on geographic location,” Sobolik told Medscape Medical News.

Currently, no loneliness screening tools exist that are specific to HIV or allow for assessing loneliness in people aging with HIV without causing additional trauma, Sobolik noted. “Further research is also necessary to quantify the impacts of loneliness interventions on secondary health outcomes and how those results vary across rural and urban settings,” she said.

Aging Adults With HIV Need Support

People with HIV are living longer lives because of improvements in antiretroviral effectiveness, Shirin Mazumder, MD, associate professor and infectious disease specialist at the University of Tennessee Health Science Center, Memphis, Tennessee, in an interview.

“Looking at factors that are unique to this group are important to determine which types of interventions and support services can be used to better assist with the aging population,” said Mazumder, who was not involved in the study. 

“As our population of people living with HIV ages, we need to consider all the different factors that may impact their quality of life,” Mazumder noted. “Loneliness can be an issue that affects many people living with HIV but can have a significant impact on morbidity and mortality for people aging with HIV, and geography can impact specific needs and interventions as well,” she said.

“Further research in this area could focus on including a larger sample size in both urban and rural regions to determine which specific needs are of highest concern and how best to intervene,” Mazumder told Medscape Medical News. “The group topics and interventions were limited in this study; also, the number of female participants was very low, and the specific concerns of female participants may be different,” she said. “Looking at a broad array of interventions as it pertains to improve loneliness and how well they work in sustaining loneliness is another area of research,” she added.

The study received no outside funding. The researchers had no financial conflicts to disclose. Mazumder had no financial conflicts to disclose.