HIV-Related Stigma, Loneliness, and Sleep Quality in Men and Women Living with HIV Erin M. Fekete, Ph.D.1, Stacey L. Williams, Ph.D.2, Matthew D. Skinta, Ph.D.3, ABPP 1University of Indianapolis, 2East Tennessee State University, 3Palo Alto University PARTICIPANTS (N = 181) ABSTRACT MEASURES People living with HIV (PLWH) experience HIV-related stigma, which is associated with poorer well-being, higher rates of loneliness. Little attention focuses on the impact of stigma on sleep. We hypothesized that HIV-related stigma would be indirectly related to sleep quality through loneliness in 181 PLWH. As predicted, the indirect effect of stigma on global sleep quality, subjective sleep quality, sleep latency, and daytime sleep dysfunction through loneliness was significant. PLWH who experience social isolation as a result of HIV-related stigma may have increased sleep disturbances, which may have health consequences, including faster disease progression. Loneliness Age Mean = 42.8 (SD = 11.0) Gender Male= 71.8%; Female= 24.9%; Transgender = 3.3% Race White= 48.1%; Black= 44.8%; Other = 7.1% Ethnicity 12.2% Hispanic Sexual Orientation 51.4% Homosexual; 36.5% Heterosexual 10.5% Bisexual; 1.7% Asexual Relationship Status 59.7% Never Married; 23.2% Married/ Cohabitating; 11.0% Divorced; 4.4% Separated; 1.4% Widowed Employment 50.8% Unemployed or on Disability Annual Income Median = $15,000 – $19,999 Time Since HIV Diagnosis Mean = 11.7 Years (SD = 8.4) b=.14, SE = .01*** b=.04, SE = .02* Measure Mean SD Actual Range Potential Range α HIV-Stigma 97.9 26.8 43-157 40-160 .97 Loneliness 18.3 6.2 8-31 8-32 .85 Global Sleep Quality 8.58 4.4 0-21 .75 Subjective Sleep Quality 1.35 .76 0-3 -- Sleep Latency 1.48 1.1 Sleep Duration 1.08 .89 Sleep Efficiency 1.02 1.2 Sleep Disturbances 1.61 .71 Use of Sleep Medication 1.04 1.3 Daytime Sleep Dysfunction 1.01 .84 HIV-Related Stigma Sleep Latency b=-.003, SE = .004 IE = .005, SE = .003, CIbootstrap = .0004 to .011, Sobel’s Z = 2.18* Loneliness b=.15, SE = .01*** b=.03, SE = .01** HIV-Related Stigma Daytime Sleep Dysfunction INTRODUCTION b=-.003, SE = .003 Sleep impairments are commonly reported in people living with HIV (PLWH), and these sleep disturbances may be related to both short and longer term health consequences. More Severe Disease Symptoms Medication Non-Adherence Poorer Well-Being Immune Impairment Faster Disease Progression Psychosocial factors such as HIV-related stigma and loneliness may contribute to sleep disturbances in PLWH. HIV-related stigma can be conceptualized as a stressful social process, and research has consistently documented a link between HIV-related stress and poor sleep quality. One way that HIV-related stigma may be associated with poor sleep quality is through increased levels of loneliness or social isolation. Compared to non-lonely individuals, lonely individuals have poorer sleep quality, longer sleep latency, shorter sleep duration, more daytime sleep dysfunction, less efficient sleep, and report more sleep disturbances. IE = .005, SE = .002, CIbootstrap = .002 to .008, Sobel’s Z = 2.84** ***p<.001; **p<.01; *p<.05 HIV-Related Stigma was not indirectly associated with Sleep Duration, Sleep Efficiency, Sleep Disturbances, or Use of Sleep Medication through Loneliness. PROCEDURE & MEASURES Participants were screened for eligibility and then completed an online questionnaire. Eligibility Criteria Over the age of 18 Diagnosed with HIV/AIDS by a health care professional Comfortable reading and responding to an online questionnaire in English Valid US mailing address Measures included: Demographic, Health, and Social Characteristics HIV-Stigma Scale UCLA-Loneliness Scale Short-Form Pittsburgh Sleep Quality Index DISCUSSION HIV-Related Stigma was indirectly associated with poorer global and subjective sleep quality, longer sleep latency, and more daytime sleep dysfunction through higher levels of loneliness. PLWH who experience social isolation as a result of HIV-related stigma may have increased sleep disturbances, which can be associated with long term health consequences, including faster disease progression. Experiencing HIV-Related Stigma may lead to increased feelings of threat and vulnerability, and PLWH may socially isolate themselves as a way of avoiding HIV-related stigma. This increased loneliness may cause increased levels of stress, which may lead to poorer sleep quality, longer transitions from wakefulness to sleep, and more daytime fatigue. Interventions focused on increasing sleep in PLWH should focus on strengthening social ties and increasing social support. RESULTS Loneliness b=.14, SE = .01*** b=.12, SE = .06* HIV-Related Stigma Global Sleep Quality ANALYSIS PLAN b=-.002, SE = .01 Mediation Analysis Using PROCESS Significance of Indirect Effects Bootstrapped Confidence Intervals Covariates in All Analyses Income, HIV-Symptom Severity, Self-Rated Health, Years Since HIV-Diagnosis Additional Covariates Sleep Duration: Race Sleep Efficiency: Age, Ethnicity Sleep Disturbances: Employment Status Use of Sleep Medication: Employment Status Daytime Sleep Dysfunction: Age IE = .02, SE = .01, CIbootstrap = .001 to .04, Sobel’s Z = 2.07* Loneliness b=.14, SE = .01*** b=.03, SE = .01* HYPOTHESIS HIV-Related Stigma Subjective Sleep Quality We hypothesized that HIV-related stigma would be indirectly related to sleep quality through loneliness, such that more HIV-related stigma would be associated with higher levels of loneliness, which in turn would be associated with poorer sleep quality. b=-.003, SE = .003 IE = .04, SE = .002, CIbootstrap = .0002 to .007, Sobel’s Z = 2.24*