AIDS and Behavior

, Volume 22, Issue 5, pp 1475–1484 | Cite as

Loneliness in Older Adults Living with HIV

  • Meredith GreeneEmail author
  • Nancy A. Hessol
  • Carla Perissinotto
  • Roland Zepf
  • Amanda Hutton Parrott
  • Cameron Foreman
  • Robert Whirry
  • Monica Gandhi
  • Malcolm John
Original Paper


We conducted a cross-sectional study among HIV-positive adults age ≥ 50 in San Francisco to evaluate the frequency of loneliness, characteristics of those who reported loneliness, and the association of loneliness with functional impairment and health-related quality of life (HRQoL). Participants (N = 356) were predominately male (85%); 57% were white; median age was 56. 58% reported any loneliness symptoms with 24% reporting mild, 22% moderate and 12% severe loneliness. Lonely participants were more likely to report depression, alcohol and tobacco use, and have fewer relationships. In unadjusted models, loneliness was associated with functional impairment and poor HRQoL. In adjusted models, low income and depression remained associated with poor HRQoL, while low income, higher VACS index and depression were associated with functional impairment. A comprehensive care approach, incorporating mental health and psychosocial assessments with more traditional clinical assessments, will be needed to improve health outcomes for the aging HIV-positive population.


HIV/AIDS Aging Loneliness Functional status Quality of life 


Realizamos un estudio transversal en adultos mayores de 50 años con VIH en San Francisco para evaluar la frecuencia de la soledad, características de aquellos que reportan soledad, y la asociación de la soledad con el deterioro funcional y la calidad de vida relacionada con la salud (HRQoL). Los participantes (N = 356) fueron principalmente hombres (85%); 57% de raza blanca, la mediana de edad fue 56 años. El 58% reportó cualquier síntoma de soledad con un 24% reportando soledad leve, 22% soledad moderada, y 12% soledad severa. En los participantes que refirieron soledad era más probable que reportaran depresión, consumo de tabaco o alcohol, y menos relaciones sociales. En modelos sin ajustar, la soledad estaba asociada con deterioro funcional y baja calidad de vida relacionada con la salud. En modelos ajustados, tener bajos ingresos y depresión continuaron teniendo asociación con una baja calidad de vida relacionada con la salud, mientras que tener bajos ingresos, un índice más alto de VACS y depresión estaban asociados con deterioro funcional. Un sistema de cuidado integral, incorporando la salud mental y valoraciones psicológicas y sociales con evaluaciones médicas tradicionales, serán necesarios para poder mejorar los índices de salud de las personas VIH positivas que envejecen.



We would like to acknowledge Terrence Marcotte, NP for his contribution to this project at San Francisco General Hospital and Bill Blum, MSW at the San Francisco Department of Public Health for his role in organizing the Silver Project. We would like to thank Daniel W. Russell, Ph.D., Professor, Department of Human Development and Family Studies at Iowa State University for his assistance with cut points for the UCLA loneliness scale. We would also like to thank Mark Brennan-Ing, Ph.D., Director for Research and Evaluation, ACRIA—Center on HIV and Aging, Adjunct Asst. Professor, NYU College of Nursing and Liz Seidel, MSW, Manager for Research and Evaluation, ACRIA—Center on HIV and Aging, Adjunct Professor, Graduate School of Social Service, Fordham University for their help in providing comparative loneliness data from the ROAH study.


This work was supported by the California HIV/AIDS Research Program (CHRP) under Grant A116894 “California HIV/AIDS Research Programs for Integrating HIV and Geriatric Care for PLWH 50 & over.” Dr. Greene receives funding from P30AG044281 from the NIA at the NIH and received salary support from NIH (5-T32-AG000212) during this project.

Compliance with Ethical Standards

Conflict of interest

Dr. John is on the speaker’s bureau and advisory boards of Gilead Sciences, Inc.; Merck & Co., Inc.; and ViiV Healthcare. Dr. Greene, Dr. Hessol, Dr. Perissinotto, Dr. Zepf, Dr. Hutton Parrott, Mr. Foreman, Mr. Whirry and Dr. Gandhi declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–33.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8(12):e81355.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015.Google Scholar
  4. 4.
    Salter ML, Lau B, Go VF, Mehta SH, Kirk GD. HIV infection, immune suppression, and uncontrolled viremia are associated with increased multimorbidity among aging injection drug users. Clin Infect Dis. 2011;53(12):1256–64.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Greene M, Justice AC, Lampiris HW, Valcour V. Management of human immunodeficiency virus infection in advanced age. JAMA. 2013;309(13):1397–405.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am Geriatr Soc. 2014;62(3):447–53.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Edelman EJ, Gordon KS, Glover J, McNicholl IR, Fiellin DA, Justice AC. The next therapeutic challenge in HIV: polypharmacy. Drugs Aging. 2013;30(8):613–28.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Karpiak SE, Shippy RA, Cantor MH. Research on older adults with HIV. New York: New York AIDS Community Research Initiative of America; 2006.Google Scholar
  9. 9.
    Carmo Filho A, Fakoury MK, Eyer-Silva Wde A, Neves-Motta R, Kalil RS, Ferry FR. Factors associated with a diagnosis of major depression among HIV-infected elderly patients. Rev Soc Bras Med Trop. 2013;46(3):352–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Peltzer K, Phaswana-Mafuya N. Depression and associated factors in older adults in South Africa. Global Health Action. 2013;6:1–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Poindexter C, Shippy RA. Networks of older New Yorkers with HIV: fragility, resilience, and transformation. AIDS Patient Care STDs. 2008;22(9):723–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work. 2006;31(4):299–308.CrossRefPubMedGoogle Scholar
  13. 13.
    Schrimshaw EW, Siegel K. Perceived barriers to social support from family and friends among older adults with HIV/AIDS. J Health Psychol. 2003;8(6):738–52.CrossRefPubMedGoogle Scholar
  14. 14.
    Shippy RA, Karpiak SE. Perceptions of support among older adults with HIV. Res Aging. 2005;27(3):290–306.CrossRefGoogle Scholar
  15. 15.
    Greysen SR, Horwitz LI, Covinsky KE, Gordon K, Ohl ME, Justice AC. Does social isolation predict hospitalization and mortality among HIV + and uninfected older veterans? J Am Geriatr Soc. 2013;61(9):1456–63.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Shippy RA, Karpiak SE. The aging HIV/AIDS population: fragile social networks. Aging Ment Health. 2005;9(3):246–54.CrossRefPubMedGoogle Scholar
  17. 17.
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hawton A, Green C, Dickens AP, Richards SH, Taylor RS, Edwards R, et al. The impact of social isolation on the health status and health-related quality of life of older people. Quality Life Res. 2011;20(1):57–67.CrossRefGoogle Scholar
  19. 19.
    Perissinotto CM, Stijacic Cenzer I, Covinsky KE. Loneliness in older persons: a predictor of functional decline and death. Arch Intern Med. 2012;172(14):1078–83.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Holwerda TJ, Beekman AT, Deeg DJ, Stek ML, van Tilburg TG, Visser PJ, et al. Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL). Psychol Med. 2012;42(4):843–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Obisesan TO. Among elderly men, feelings of loneliness are associated with increased 10-year mortality risk, independent of social isolation and medical and psychiatric conditions. Evid Based Nurs. 2013;16(2):66–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Perissinotto CM, Covinsky KE. Living alone, socially isolated or lonely—what are we measuring? J Gen Intern Med. 2014;29(11):1429–31.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Stanton CA, Moadel AB, Kim RS, Weinberger AH, Shuter J. Loneliness in HIV-infected smokers. AIDS Care. 2015;27(2):268–72.CrossRefPubMedGoogle Scholar
  25. 25.
    Nachega JB, Morroni C, Zuniga JM, Sherer R, Beyrer C, Solomon S, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Phys AIDS Care (Chic). 2012;11(3):172–8.CrossRefGoogle Scholar
  26. 26.
    Miles MS, Isler MR, Banks BB, Sengupta S, Corbie-Smith G. Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV in the rural south. Qual Health Res. 2011;21(4):489–501.CrossRefPubMedGoogle Scholar
  27. 27.
    Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010;22(5):630–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Alpass FM, Neville S. Loneliness, health and depression in older males. Aging Ment Health. 2003;7(3):212–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012;74(6):907–14.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    John MD, Greene M, Hessol NA, Zepf R, Parrott AH, Foreman C, et al. Geriatric assessments and association with VACS index among HIV-infected older adults in San Francisco (1999). J Acquir Immune Defic Syndr. 2016;72(5):534–41.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Hays RD, DiMatteo MR. A short-form measure of loneliness. J Pers Assess. 1987;51(1):69–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Russell D, Peplau LA, Cutrona CE. The revised UCLA loneliness scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980;39(3):472–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Crane HM, Van Rompaey SE, Dillingham PW, Herman E, Diehr P, Kitahata MM. A single-item measure of health-related quality-of-life for HIV-infected patients in routine clinical care. AIDS Patient Care STDS. 2006;20(3):161–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Freedberg KA, Losina E, Weinstein MC, Paltiel AD, Cohen CJ, Seage GR, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med. 2001;344(11):824–31.CrossRefPubMedGoogle Scholar
  35. 35.
    DeSalvo KB, Fan VS, McDonell MB, Fihn SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40(4):1234–46.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Manor O, Matthews S, Power C. Self-rated health and limiting longstanding illness: inter-relationships with morbidity in early adulthood. Int J Epidemiol. 2001;30(3):600–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.CrossRefPubMedGoogle Scholar
  38. 38.
    Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H, et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr. 2015;69(2):161–7.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94(3):135–40.PubMedGoogle Scholar
  41. 41.
    Justice AC, McGinnis KA, Skanderson M, Chang CC, Gibert CL, Goetz MB, et al. Towards a combined prognostic index for survival in HIV infection: the role of ‘non-HIV’ biomarkers. HIV Med. 2010;11(2):143–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMedGoogle Scholar
  44. 44.
    Milanini B, Wendelken LA, Esmaeili-Firidouni P, Chartier M, Crouch PC, Valcour V. The montreal cognitive assessment to screen for cognitive impairment in HIV patients older than 60 years. J Acquir Immune Defic Syndr. 2014;67(1):67–70.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Lubben JE. Assessing social networks among elderly populations. Fam Commun Health. 1988;11:42–52.CrossRefGoogle Scholar
  46. 46.
    Shiovitz-Ezra S, Ayalon L. Situational versus chronic loneliness as risk factors for all-cause mortality. Int Psychogeriatr. 2010;22(3):455–62.CrossRefPubMedGoogle Scholar
  47. 47.
    Vance DE. Self-rated emotional health in adults with and without HIV. Psychol Rep. 2006;98(1):106–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Emlet CA, Tozay S, Raveis VH. “I’m not going to die from the AIDS”: resilience in aging with HIV disease. Gerontologist. 2011;51(1):101–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Fokkema T, Kuyper L. The relation between social embeddedness and loneliness among older lesbian, gay, and bisexual adults in the Netherlands. Arch Sex Behav. 2009;38(2):264–75.CrossRefPubMedGoogle Scholar
  50. 50.
    Valtorta N, Hanratty B. Loneliness, isolation and the health of older adults: do we need a new research agenda? J R Soc Med. 2012;105(12):518–22.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Owen G, Catalan J. ‘We never expected this to happen’: narratives of ageing with HIV among gay men living in London, UK. Cult Health Sex. 2012;14(1):59–72.CrossRefPubMedGoogle Scholar
  52. 52.
    Emlet CA, Shiu C, Kim HJ, Fredriksen-Goldsen K. Bouncing back: resilience and mastery among HIV-positive older gay and bisexual men. Gerontologist. 2017;57(suppl 1):S40–9.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Vance DE. The cognitive consequences of stigma, social withdrawal, and depression in adults aging with HIV. J Psychosoc Nurs Ment Health Serv. 2013;51(5):18–20.CrossRefPubMedGoogle Scholar
  54. 54.
    Rodkjaer L, Laursen T, Balle N, Sodemann M. Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark. HIV Med. 2010;11(1):46–53.CrossRefPubMedGoogle Scholar
  55. 55.
    San Francisco Department of Public Health HIV Semi-annual Surveillance Report. 2016.Google Scholar
  56. 56.
    Golub SA, Tomassilli JC, Pantalone DW, Brennan M, Karpiak SE, Parsons JT. Prevalence and correlates of sexual behavior and risk management among HIV-positive adults over 50. Sex Transm Dis. 2010;37(10):615–20.PubMedGoogle Scholar
  57. 57.
    Hubach RD, Dodge B, Li MJ, Schick V, Herbenick D, Ramos WD, et al. Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM). AIDS Educ Prev. 2015;27(1):72–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Meredith Greene
    • 1
    Email author return OK on get
  • Nancy A. Hessol
    • 2
    • 3
  • Carla Perissinotto
    • 1
  • Roland Zepf
    • 3
  • Amanda Hutton Parrott
    • 3
  • Cameron Foreman
    • 4
  • Robert Whirry
    • 5
  • Monica Gandhi
    • 6
  • Malcolm John
    • 3
  1. 1.Division of Geriatrics, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Clinical PharmacyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Division of Infectious Diseases, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  4. 4.University of Iowa Carver College of MedicineIowa CityUSA
  5. 5.Robert Whirry & AssociatesLos AngelesUSA
  6. 6.Division of HIV, Infectious Diseases, and Global Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA

Personalised recommendations