Loneliness and Frailty Among Middle-Aged and Aging Sexual Minority Men Living With or Without HIV: A Longitudinal Cross-Lagged Panel Analysis.

Background and Objectives: Loneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study. Research Design and Methods: We used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated. Results: The estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23-3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI: .44-2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94-46) and loneliness (aOR = 13.94; 95% CI: 9.42-20.61) were large. Discussion and Implications: Men who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV.

Negative Perception of Aging Is Associated With Frailty Transitions Within a Cohort of Sexual Minority Men.

BACKGROUND AND OBJECTIVES: Older people have an increased risk of developing frailty, an age-related clinical syndrome associated with worse health outcomes. This study examined the effect of self-perception of aging (ie, age discrepancy-individuals feel younger/older than their chronological age and aging satisfaction) on frailty transitions. RESEARCH DESIGN AND METHODS: We use longitudinal data from 549 HIV-/499 HIV+ sexual minority men aged 50 years or older enrolled in the Multicenter AIDS Cohort Study. To test the association of self-perception of aging on transitions between states of frailty (nonfrail/frail), defined using Fried Frailty Phenotype, a multinomial modeling was used. RESULTS: With remaining nonfrail as the referent group, participants reporting low aging satisfaction (vs moderate aging satisfaction) had increased odds of transitioning from nonfrail to frail (odds ratio [OR]: 2.72; 95% confidence interval [CI]: 1.56-4.74), frail to nonfrail (OR: 3.40; 95% CI: 1.62-7.12), or remaining frail (frail to frail; OR: 6.64; 95% CI: 3.88-11.38). Participants reporting older subjective age (vs no age discrepancy) had increased odds of transitioning from nonfrail to frail (OR: 2.50; 95% CI: 1.11-5.64), frail to nonfrail (OR: 4.47; 95% CI: 1.85-10.81), or remaining frail (frail to frail; OR: 5.68; 95% CI: 3.06-10.56). High aging satisfaction and younger subjective age were not statistically associated with frailty transitions. DISCUSSION AND IMPLICATIONS: Our findings show that negative self-perception of aging (ie, older subjective age and low aging satisfaction) is associated with frailty transitions (nonfrail to frail, frail to nonfrail, and frail to frail) when compared to remaining nonfrail.

Self-perception of aging among HIV-positive and HIV-negative participants in the Multicenter AIDS Cohort Study.

Self-perception of aging is an important predictor of quality of life. Therefore, we sought to examine self-perceptions of aging (age discrepancy and aging satisfaction) between HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS). We included 835 HIV-negative and 784 HIV-positive men aged 50 years and older who had completed a survey about age discrepancy and aging satisfaction from the "Attitude toward own aging" subscale of the Philadelphia Geriatric Center Morale scale. Multinomial generalized logit models were generated to assess self-perception of aging by HIV-status. Most of the participants self-identified as white, former smokers, and had completed high school. HIV-positive individuals reported higher prevalence of comorbidities than HIV-negative individuals. After adjusting for covariates, positive age discrepancy (older subjective age) was positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. Low aging satisfaction was associated with being a current and former smoker and having depressive symptoms, diabetes, and no age and positive age discrepancy. Being black had decreased odds of low aging satisfaction. These findings should inform health care professionals to promote positive views of aging in the assessment and management of HIV, depression, and diabetes.

Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV.

Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American (N = 1,157) and White (N = 400) men with HIV infection and comparable HIV-negative men (n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.

Sexual Migration and HIV Risk in a Sample of Brazilian, Colombian and Dominican Immigrant MSM Living in New York City.

We examined motivations for migration to the United States (US) among 482 Brazilian, Colombian, and Dominican men who have sex with men (MSM). Participants' most common reason for migration was to improve their financial situation (49%), followed by sexual migration in order to affirm their sexual orientation (40%). Fewer endorsed sexual migration motivated by avoiding persecution due to being gay (13%). We conducted further analyses among 276 participants who migrated after age 15 and were HIV-negative at the time of migration. We hypothesized that sexual migration would be associated with greater likelihood of HIV acquisition post-migration. Hierarchical logistic regression analysis indicated that sexual migration motivated by avoiding persecution due to being gay was associated with increased odds of contracting HIV after arrival in the US whereas sexual migration to lead a gay life was not. Our findings highlight the importance of addressing the negative impact of anti-gay discrimination in countries of origin.

Anti-LGBT Victimization, Fear of Violence at School, and Suicide Risk Among Adolescents.

We investigated whether strengths of the relationships between anti-lesbian, gay, bisexual, and transgender (LGBT) victimization, fear of violence at school, and suicide risk differ by sexual orientation among a predominantly ethnic minority sample of adolescents. Using the 2012 District of Columbia Youth Risk Behavior Survey high school data set, we performed a 4-stage, stepwise logistic regression for suicide attempts, suicidal ideation, and suicide planning. First, we tested the independent variables, sexual orientation and anti-LGBT victimization. Second, we added an anti-LGBT victimization by sexual orientation interaction term. Third, we tested the independent variable, fear of violence at school, in an additive model. Fourth, we added a fear of violence at school by sexual orientation interaction term. In Model 1, sexual orientation and anti-LGBT victimization were both significantly associated with each suicide risk behavior. In Model 2, the anti-LGBT victimization by sexual orientation interaction term was not significant for any of the dependent variables. In Model 3, fear of violence at school was significantly associated with each suicide risk behavior. In Model 4, the fear of violence at school by sexual orientation interaction term was not significant for suicide attempts or suicidal ideation but was significant for suicide planning in the direction opposite to our hypotheses. Anti-LGBT victimization, sexual orientation, and fear of violence at school were associated with suicidal ideation, suicide planning, and suicide attempts. The strength of the association between fear of violence at school and suicide planning was weaker for sexual minority adolescents than for heterosexual adolescents.

Enhanced immigration enforcement in the USA and the transnational continuity of HIV care for Latin American immigrants in deportation proceedings.

In our work as clinicians, researchers, and immigrant rights advocates, we have noted increased anxiety about the possibility of deportation and disruptions in care among immigrants with HIV. Before the 2016 US elections, patients rarely asked about HIV treatment in their home countries. However, since the increase in anti-immigrant rhetoric and arrests by US Immigration and Customs Enforcement, patients have voiced concerns about the availability of HIV treatment in their home countries much more frequently. Although antiretroviral therapy is available throughout Latin America, access depends on economic, social, and political circumstances. Maintaining uninterrupted continuity of care among immigrants held in detention or deported to their home countries is challenging. In this Viewpoint, we identify periods of particular vulnerability for immigrants during deportation proceedings, from initial detention to deposition in their country of origin. We discuss the effect of enhanced immigration enforcement on the health and wellbeing of HIV-infected immigrants, and on public health. Finally, we also discuss recommendations for clinicians, immigration authorities, and public health institutions in the USA and in receiving countries.

Development and Implementation of an HIV Health Care Practice Transformation Model for Latinos.

A Latino Community Health Center in Washington, D.C. implemented and evaluated a practice transformative model to optimize human resources and improve quality health outcomes in HIV service delivery for Latino patients. We conducted a qualitative formative assessment through interviews and focus groups with clinic staff and patients living with HIV/AIDS in order to inform implementation. The formative assessment identified specific training and practice facilitation needs and provided valuable insight for choosing evaluation metrics. Incorporating staff input fostered staff engagement in laying the foundation of the transformation and helped build a sense of ownership of the transformative process. Through the formative assessment process we gained insight into the organization's HIV practice and improved our ability to align practice transformation goals with evaluation metrics to better measure changes resulting from the model implementation. The formative assessment process also highlighted challenges in conducting health systems research with Latino communities in the U.S.

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs.

Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.

Greater Depressive Symptoms and Higher Viral Load Are Associated with Poor Physical Function among Latino Men Living with HIV.

Physical function limitations have been associated with poor health outcomes, which have a negative impact on quality of life of older individuals. This study examined the association between depression, viral load, and acculturation with physical function among Latino men living with HIV. A secondary data analysis was performed using a cross-sectional data of 146 Latino immigrant men living with HIV in New York City and Washington, DC. Physical function was measured using the Short-Form Health Survey (SF-12). Uncontrolled HIV infection and depression were associated with worse physical function, thus implying the importance of adequate health care to address these conditions. Preserving physical function should start during middle adulthood, particularly among people living with HIV because of their greater risk of developing age-related challenges such as depression, diabetes, cardiovascular diseases among others. This study informs future interventions to preserve physical function and achieve the goal of successful aging.