The goals of the proposed study are to examine one possible pathway of how social isolation affects important self-management behaviors such as adherence to routine HIV care appointments (i.e., retention in care), and to develop an understanding of unique factors associated with perceived isolation in older persons living with HIV (PLWH). More than 50% of the US HIV population is projected to be over 50 years of age by 2017. Transformation of HIV infection from an acute infection to a chronic condition associated with multi-morbidities requires lifelong surveillance and disease management. Retention in care is important for improving general health and managing emerging morbidities as well as the now-chronic HIV infection. Effective management of chronic conditions requires adequate social support, yet studies have shown that older PLWH are socially isolated and have reduced support. Social isolation manifests in two forms?social connectedness and perceived isolation? yet studies in HIV aging have focused mainly on the indicators of social disconnectedness. Perceived isolation, colloquially referred to as loneliness, is highly prevalent among seronegative older adults and is an emerging concern expressed by older PLWH. Although perceived isolation has been linked to numerous health outcomes through diminished emotion regulation and poor health behaviors in seronegative adults, no study has examined factors related to and outcomes of perceived isolation among older PLWH.
The aims of this study are toassess the potential mediating effect of emotion regulation in the association between social isolation (social disconnectedness and perceived isolation) and retention in care, and to assess the relationship of demographic factors, HIV-stigma, HIV disclosure status, functional status, and social disconnectedness to perceived social isolation in older PLWH. An exploratory aim will examine how these aims may differ by race or gender to gain some preliminary understanding of possible subgroup differences. A total of 140 PLWH who are 50 years old or older will be recruited from outpatient HIV clinics in Atlanta, GA. Descriptive, correlation, regression analysis, and path analysis will be used to statistically analyze the aims. Completion of the proposed study is a first-step towards understanding the impact of social isolation on health, developing targeted interventions to reduce perceived isolation and promote retention in care, and improving health outcomes in this ever-growing population.

Public Health Relevance

Older adults living with HIV/AIDS are socially isolated compared to their younger counterparts and report feelings of loneliness. This study aims to examine one potential mechanism by which social isolation affects self-management behavior, namely adherence to routine HIV care appointments (i.e., retention in care), and to identify factors related to perceived isolation (i.e., loneliness) that may be uniquely present in HIV-infected older adults. Information gained from this study may advance the field of HIV and aging in relation to the effects of social isolation on health, and may help develop targeted interventions to reduce perceived isolation and improve retention in care.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (NRRC (65))
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Banks, David
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Emory University
Schools of Nursing
United States
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Yoo-Jeong, Moka; Anderson, Ashley; Rahman, Akm Fazlur et al. (2018) Associations of Mood on Objective and Subjective Cognitive Complaints in Persons Living with HIV/AIDS. J HIV AIDS 4: