Sexual Behavior and Perceived Loneliness in Elderly People Living with HIV in China during the COVID-19 Pandemic
Abstract
:1. Introduction
2. Methods
2.1. Two-Stage Stratified Cluster Sampling
2.2. Data Collection and Management
2.3. Measures of Loneliness and HIV Disclosure Status and Discrimination
2.3.1. Loneliness
2.3.2. HIV Disclosure Status and Discrimination
2.4. Statistical Analysis
3. Results
3.1. Demographic Characteristics of Older PLHIV
3.2. HIV-Related Characteristics of Respondents
3.3. Risk Factor Analysis of Loneliness among Older People Living with HIV
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ding, Y.; Ma, Z.; He, J.; Xu, X.; Qiao, S.; Xu, L.; Shi, R.; Xu, X.; Zhu, B.; Li, J.; et al. Evolving HIV Epidemiology in Mainland China: 2009–2018. Curr. HIV/AIDS Rep. 2019, 16, 423–430. [Google Scholar] [CrossRef] [PubMed]
- He, N.; Ding, Y.; Li, J.; Yuan, S.; Xu, L.; Qiao, S.; Xu, X.; Zhu, B.; Shi, R.; Barile, J.P.; et al. HIV and Aging in Mainland China: Implications for Control and Prevention Research. Curr. HIV/AIDS Rep. 2019, 16, 439–447. [Google Scholar] [CrossRef] [PubMed]
- Kraav, S.-L.; Lehto, S.M.; Junttila, N.; Ruusunen, A.; Kauhanen, J.; Hantunen, S.; Tolmunen, T. Depression and loneliness may have a direct connection without mediating factors. Nord. J. Psychiatry 2021, 75, 553–557. [Google Scholar] [CrossRef] [PubMed]
- O’Súilleabháin, P.S.; Gallagher, S.; Steptoe, A. Loneliness, Living Alone, and All-Cause Mortality: The Role of Emotional and Social Loneliness in the Elderly During 19 Years of Follow-Up. Psychosom. Med. 2019, 81, 521–526. [Google Scholar] [CrossRef] [PubMed]
- Xia, N.; Li, H. Loneliness, Social Isolation, and Cardiovascular Health. Antioxid. Redox Signal. 2018, 28, 837–851. [Google Scholar] [CrossRef] [PubMed]
- Ng, T.K.S.; Visaria, A.; Ma, S.; Chan, A.W.-M. Differential Effects of Loneliness and Depression on Mortality. J. Am. Med Dir. Assoc. 2020, 22, 476–478.e2. [Google Scholar] [CrossRef]
- Zhou, Z.; Mao, F.; Zhang, W.; Towne, J.S.D.; Wang, P.; Fang, Y. The Association Between Loneliness and Cognitive Impairment among Older Men and Women in China: A Nationwide Longitudinal Study. Int. J. Environ. Res. Public Health 2019, 16, 2877. [Google Scholar] [CrossRef]
- Wang, G.; Hu, M.; Xiao, S.-Y.; Zhou, L. Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: A cross-sectional study. BMJ Open 2017, 7, e016091. [Google Scholar] [CrossRef]
- Niu, S.; Bartolome, A.; Mai, C.; Ha, N.B. #StayHome #WithMe: How Do YouTubers Help with COVID-19 Loneliness? In Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems (CHI’21), Yokohama, Japan, 8–13 May 2021.
- Zhang, J.; Xu, L.; Li, J.; Sun, L.; Ding, G.; Qin, W.; Wang, Q.; Zhu, J.; Yu, Z.; Xie, S. Loneliness and Health Service Utilization among the Rural Elderly in Shandong, China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2018, 15, 1468. [Google Scholar] [CrossRef]
- Lellouche, L.; Gutierrez, L.-A.; Leclercq, P.; Zaegel-Faucher, O.; Bernard, L.; Vassallo, M.; Barbuat, C.; Ozguler, A.; Zins, M.; Nailler, L.; et al. Brief Report: Frailty in Aging People Living With HIV: A Matched Controlled Study. Am. J. Ther. 2021, 88, 305–309. [Google Scholar] [CrossRef]
- Yushchuk, N.D.; Gadzhikulieva, M.M.; Balmasova, I.P.; Volgina, G.V.; Gultyaev, M.M. The role of immune factors in the progression of chronic kidney diseases in HIV infection. Ter. Arkhiv 2016, 88, 56–61. [Google Scholar] [CrossRef] [PubMed]
- Shippy, R.A.; Karpiak, S.E. The aging HIV/AIDS population: Fragile social networks. Aging Ment. Health 2005, 9, 246–254. [Google Scholar] [CrossRef] [PubMed]
- Han, S.; Hu, Y.; Wang, L.; Pei, Y.; Zhu, Z.; Qi, X.; Wu, B. Perceived discrimination and mental health symptoms among persons living with HIV in China: The mediating role of social isolation and loneliness. AIDS Care 2021, 33, 575–584. [Google Scholar] [CrossRef] [PubMed]
- Huang, Y.M.; Qiu, Z.B.; Li, Z.F.; Liang, G.Q.; Yang, J.; Lu, W.T.; Jiang, J.J. Analysis of HIV-related sexual behavior and its influencing factors among elderly people in the rural area of Guangxi. Chin. J. AIDS STD 2018, 24, 1106–1109. [Google Scholar]
- Dong, Z.; Ma, L.; Cai, C.; Gao, G.F.; Lyu, F. Demographic features of identified PLWHA infected through commercial and nonmarital noncommercial heterosexual contact in China from 2015 to 2018: A retrospective cross-sectional study. BMC Infect. Dis. 2021, 21, 71. [Google Scholar] [CrossRef]
- Serovich, J.M.; Laschober, T.C.; Brown, M.J.; Kimberly, J.A. Longitudinal Findings on Changes in and the Link Between HIV-Related Communication, Risky Sexual Behavior, and Relationship Status in Men Who Have Sex with Men Living With HIV. Sex. Transm. Dis. 2017, 44, 732. [Google Scholar] [CrossRef]
- Kohout, F.J.; Berkman, L.F.; Evans, D.A.; Cornoni-Huntley, J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J. Aging Health 1993, 5, 179–193. [Google Scholar] [CrossRef]
- Holwerda, T.J.; Deeg, D.J.; Beekman, A.T.; Van Tilburg, T.G.; Stek, M.L.; Jonker, C.; Schoevers, R.A. Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL). J. Neurol. Neurosurg. Psychiatry 2014, 85, 135–142. [Google Scholar] [CrossRef]
- Su, X.; Zhou, A.N.; Li, J.; Shi, L.-E.; Huan, X.; Yan, H.; Wei, C. Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China. Arch. Sex. Behav. 2017, 47, 1959–1968. [Google Scholar] [CrossRef]
- Benson, T.; Seers, H.; Webb, N.; McMahon, P. Development of social contact and loneliness measures with validation in social prescribing. BMJ Open Qual. 2021, 10, e001306. [Google Scholar] [CrossRef]
- Wang, Y.Y.; Yang, Y.; Chen, C.; Zhang, L.; Ng, C.H.; Ungvari, G.S.; Zhang, X.D.; Xiang, Y.T. Older adults at high risk of HIV infection in China: A systematic review and meta-analysis of observational studies. PeerJ 2020, 8, e9731. [Google Scholar] [CrossRef] [PubMed]
- Palmer-Hague, J.L.; Wong, S.T.; Wassersug, R.J.; Kingstone, A.; Wibowo, E. Hormones and visual attention to sexual stimuli in older men: An exploratory investigation. Aging Male Off. J. Int. Soc. Study Aging Male 2021, 24, 106–118. [Google Scholar] [CrossRef] [PubMed]
- Tepper, L. The Background and Rationale Behind the Establishment of the First AIDS and the Elderly GSA Interest Group. Innov. Aging 2020, 4, 848. [Google Scholar] [CrossRef]
- Upoalkpajor, J. Stigmatisation and Discrimination against People Living with HIV and AIDS in Agona Swedru and Coping Strategies. Int. J. Humanit. Soc. Stud. 2021, 9, 65–71. [Google Scholar] [CrossRef]
- Feng, C.; Tan, H.; Fu, L.; Zeng, H. Qualitative study on psychological experience of elderly people living with HIV over 50 years old. Chin. J. AIDS STD 2019, 25, 40–42+47. [Google Scholar]
- Wang, W.; Liu, W.; Chen, T.; Liu, N.P.; Zheng, Y.J.; Ye, S.D.; Zhang, Y.; Wang, X.M.; Wang, G.Z.; Zhang, H.B. Factors influencing antiretroviral therapy adherence among HIV-infected people on antiretroviral therapy in Ili Kazakh Autonomous Prefecture. Zhonghua Yu Fang Yi Xue Za Zhi Chin. J. Prev. Med. 2017, 51, 160–164. [Google Scholar]
- Ma, X.; Zhang, X.; Guo, X.; Lai, K.H.; Vogel, D. Examining the role of ICT usage in loneliness perception and mental health of the elderly in China. Technol. Soc. 2021, 67, 101718. [Google Scholar] [CrossRef]
- Charlotte, N.; Paula, D. Loneliness and Social Isolation among Older People in Northern Ireland. Innov. Aging 2020, 642. [Google Scholar]
- Cai, L.; Mei, Z.H.; Fan, T.L.; Li, Q.J.; Yao, Y.; Yan, H.X.; Lu, D.H. Impact of Risk Perception about COVID-19 on the Coping Behavior of the Elderly: Mediating Role of Self-Efficacy. J. Psychosom. Med. Res. 2021, 3, 61–68. [Google Scholar]
Characteristics | Total (%) | Not Lonely (%) | Lonely (%) | p-Value |
---|---|---|---|---|
Median age (IQR) | 66 (63–71) | 66 (63–71) | 66 (63–70) | |
60–69 | 704 (69.2) | 505 (70.8) | 199 (65.5) | 0.090 |
≥70 | 313 (30.8) | 208 (29.2) | 105 (34.5) | |
Gender | 0.077 | |||
Male | 776 (76.3) | 555 (77.8) | 221 (72.7) | |
Female | 241 (23.7) | 158 (22.2) | 83 (27.3) | |
Registered residence | 0.002 | |||
Rural | 564 (55.5) | 373 (52.3) | 191 (62.8) | |
Urban | 453 (44.5) | 340 (47.7) | 113 (37.2) | |
Educational level | 0.002 | |||
Primary school or illiterate | 434 (42.7) | 292 (41.0) | 142 (46.7) | |
Middle school | 500 (49.2) | 349 (48.9) | 151 (49.7) | |
College and above | 83 (8.2) | 72 (10.1) | 11 (3.6) | |
Marital status | 0.000 | |||
Unmarried | 64 (6.3) | 44 (6.2) | 20 (6.6) | |
Married or remarried | 590 (58.0) | 459 (64.4) | 131 (43.1) | |
Divorced or widowed | 363 (35.7) | 210 (29.5) | 153 (50.3) | |
Living situation | 0.000 | |||
Alone | 341 (33.5) | 187 (26.2) | 154 (50.7) | |
Others | 676 (66.5) | 526 (73.8) | 150 (49.3) | |
Have friends | 0.000 | |||
Yes | 556 (54.7) | 418 (58.6) | 138 (45.4) | |
No | 461 (45.3) | 295 (41.4) | 166 (54.6) | |
Using smartphone | 0.023 | |||
Yes | 426 (41.9) | 315 (44.2) | 111 (36.5) | |
No | 591 (58.1) | 398 (55.8) | 193 (63.5) |
Characteristics | Total | Not Lonely | Lonely | p-Value |
---|---|---|---|---|
N (%) | N (%) | N (%) | ||
Infection routes | 0.004 | |||
Homosexual contact | 166 (16.3) | 134 (18.8) | 32 (10.5) | |
Heterosexual contact | 835 (82.1) | 567 (79.5) | 268 (88.2) | |
Others | 16 (1.6) | 12 (1.7) | 4 (1.3) | |
Years since HIV diagnosis | 0.001 | |||
<1 | 153 (15.0) | 91 (12.8) | 62 (20.4) | |
1–5 | 457 (44.9) | 315 (44.2) | 142 (46.7) | |
>5 | 407 (40.0) | 307 (43.1) | 100 (32.9) | |
Disclosure status and discrimination | 0.000 | |||
Not informing anyone | 291 (28.6) | 215 (30.2) | 76 (25.0) | |
No discriminatory behavior | 584 (57.4) | 439 (61.6) | 145 (47.7) | |
Suffering discriminatory behavior | 142 (14.0) | 59 (8.3) | 83 (27.3) | |
On ART | 0.267 | |||
Yes | 944 (92.8) | 666 (93.4) | 278 (91.4) | |
No | 73 (7.2) | 47 (6.6) | 26 (8.6) | |
CD4 counts (cells per mm3) | 0.312 | |||
<200 | 158 (15.9) | 106 (15.1) | 52 (17.7) | |
≥200 | 837 (84.1) | 595 (84.9) | 242 (82.3) | |
Sexual orientation | 0.037 | |||
Homosexuality | 101 (9.9) | 81 (11.4) | 20 (6.6) | |
Heterosexuality | 863 (84.9) | 592 (83.0) | 271 (89.1) | |
Bisexuality or other | 53 (5.2) | 40 (5.6) | 13 (4.3) | |
Sexual needs | 0.599 | |||
Yes | 240 (23.6) | 165 (23.1) | 75 (24.7) | |
No | 777 (76.4) | 548 (76.9) | 229 (75.3) | |
Number of sexual partners | 0.000 | |||
Two or more | 34 (3.3) | 17 (2.4) | 17 (5.6) | |
One | 163 (16.0) | 132 (18.5) | 31 (10.2) | |
None | 820 (80.6) | 564 (79.1) | 256 (84.2) |
Characteristics | Feeling Lonely N (%) | Unadjusted OR (95% CI) | p | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|---|
Gender | |||||
Male | 221 (28.5) | 1 | 1 | ||
Female | 83 (34.4) | 1.319 | 0.078 | 1.542 (1.084, 2.193) | 0.016 |
Discrimination from informed people | |||||
Did not inform anyone | 76 (26.1) | 1 | 1 | ||
No discriminatory behavior | 145 (24.8) | 0.934 | 0.680 | 1.038 (0.734, 1.468) | 0.834 |
Suffered discriminatory behavior | 83 (58.5) | 3.980 | 0.000 | 4.719 (2.986, 7.459) | 0.000 |
Years since HIV diagnosis | |||||
<1 | 62 (40.5) | 2.092 | 0.000 | 2.061 (1.345, 3.156) | 0.001 |
1–5 | 142 (31.1) | 1.384 | 0.034 | 1.304 (0.938, 1.812) | 0.114 |
>5 | 100 (24.6) | 1 | 1 | ||
Living alone | |||||
No | 150 (22.2) | 1 | 1 | ||
Yes | 154 (45.2) | 2.888 | 0.000 | 2.314 (1.632, 3280) | 0.000 |
Have friends | |||||
Yes | 138 (24.8) | 1 | 1 | ||
No | 166 (36.0) | 1.704 | 0.000 | 1.779 (1.327, 2.386) | 0.000 |
Marital status | |||||
Married or remarried | 131 (22.2) | 1 | 1 | ||
Unmarried | 20 (31.3) | 1.593 | 0.105 | 1.056 (0.553, 2.019) | 0.868 |
Divorced or widowed | 153 (42.1) | 2.553 | 0.000 | 1.686 (1.174, 2.421) | 0.005 |
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Hou, Y.; Cai, C.; Tang, H.; Jin, Y.; Chen, F.; Niu, D.; Lv, F. Sexual Behavior and Perceived Loneliness in Elderly People Living with HIV in China during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2023, 20, 2714. https://doi.org/10.3390/ijerph20032714
Hou Y, Cai C, Tang H, Jin Y, Chen F, Niu D, Lv F. Sexual Behavior and Perceived Loneliness in Elderly People Living with HIV in China during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2023; 20(3):2714. https://doi.org/10.3390/ijerph20032714
Chicago/Turabian StyleHou, Yushan, Chang Cai, Houlin Tang, Yichen Jin, Fangfang Chen, Dandan Niu, and Fan Lv. 2023. "Sexual Behavior and Perceived Loneliness in Elderly People Living with HIV in China during the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 20, no. 3: 2714. https://doi.org/10.3390/ijerph20032714