1. 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 = 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 = to .007, Sobel’s Z = 2.24*