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

“Loneliness contributes negatively to morbidity and mortality in all older adults, and a large percentage of people living with HIV are over 50,” said lead author Jennifer Sobolik, MSN, of Complete Health, Rapid City, Dakota. South. , in an interview.

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

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

Sobolik and Alves analyzed an urban program that served 14 patients and a rural program that served 15 patients. Demographics were similar between groups; the median number of years 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 male, and 50% and 60% of the urban and rural groups they were white people. The mean age of participants in the urban and rural groups was 56 and 57 years, respectively, and approximately 29% and 60%, respectively, were gay.

The groups had broadly similar themes, including holistic health, non-HIV topics for group discussion, and enhanced program participation 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 discussion themes. Participants in the urban group preferred a home or building location and were more likely to request personal invitations or an escort to the group location. Urban participants also expressed interest in free group activities, such as trips to the zoo or library, Sobolik noted. Top topics of discussion in the urban group included end-of-life care, sexual health, loneliness, immunizations, and conflict resolution.

Specific rural 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 community aged care.

“As nurses who have cared for people living with HIV for many years, we were not surprised to find that people want to connect with others who share their life experience,” Sobolik said. Medscape Medical News. “We were interested in discovering the impact that loneliness has on overall health and how much loneliness can be alleviated through simple interventions such as small group meetings 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 loneliness was caused by stigma and lack of connection. Both groups saw increased participation when food and supplies were provided at gatherings, which would require funding to continue, they noted.

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

However, “the results suggest that interventions for people aging with HIV should be tailored to fit the needs of specific populations, recognizing that needs may vary by geographic location,” Sobolik said. Medscape Medical News.

Currently, there are no loneliness screening tools that are specific to HIV or that allow for the assessment of loneliness in people aging with HIV without causing additional trauma, Sobolik noted. “Further research is needed to quantify the impact of loneliness interventions on secondary health outcomes and how these outcomes vary across rural and urban settings,” she said.

Older adults with HIV need support

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

“Looking at factors that are unique to this group is important in determining what types of interventions and support services can be used to better help the older 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 can affect their quality of life,” noted Mazumder. “Loneliness can be a problem affecting many people living with HIV, but it can have a significant impact on morbidity and mortality for people aging with HIV, and geography can affect specific needs and interventions,” she said.

“Further research in this area could focus on including a larger sample in both urban and rural areas to determine which specific needs are of greatest concern and how best to intervene” , Mazumder said. Medscape Medical News. “Group subjects 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 range of interventions in terms of improving loneliness and how well they work in supporting loneliness is another area of ​​research,” she added.

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