Social Connectedness, Loneliness, and Health Among Aging Black Sexual Minority Men

SUMMARY/ABSTRACT Health disparities affecting older adults reflect disparities across the life span with the added burden of ageism. Black sexual minority men (BSMM) in particular, who comprise a substantial proportion of people with HIV, are affected by large health disparities for multiple mental and physical health indicators that increase with age.

Aging sexual minority men and Black adults show low social connectedness (loneliness and social isolation), which can lead to poor health outcomes. This application, submitted under PAR-21-350, proposes to use a longitudinal mixed methods social network study to examine how changes in loneliness and social isolation are

related to changes in health and wellness among aging BSMM, and how multileveled social-ecological contextual factors may mediate and moderate these associations, following the Sexual and Gender Minority Health Framework and social isolation and intersectional stigma theories. The Specific Aims are to: (1) Test

associations of longitudinal trajectories of social disconnectedness (loneliness, social isolation) with mental and physical health behaviors (healthcare engagement, adherence), quality of life, and chronic health conditions (including HIV-related outcomes) among aging BSMM, a population that shows accelerated aging effects (due

to physiological “weathering” effects of systemic discrimination, and potentially, from HIV and its treatment); (2) Examine structural (regional), community (neighborhood), social network (interpersonal), and individual level resilience and risk factors that may explain, buffer, or amplify impacts of social disconnectedness on health

among BSMM; and (3) Engage with community experts to interpret results and discuss next steps for feasible and acceptable multi-level interventions to increase positive social connections among aging BSMM. We will recruit 400 Black SMM (200 with HIV, 200 without HIV) aged 40 and older, with a focus on high-priority

jurisdictions for the US Ending the HIV Epidemic initiative in Southern California and the state of Alabama. Participants will be surveyed at baseline, 6-months, and 12-months; a subset of 80 participants will complete longitudinal in-depth interviews to explain quantitative ratings of loneliness and isolation, and connections and

subgroups depicted on their social network diagram, as well as to suggest ideas for potential interventions to address social disconnectedness (e.g., social prescribing, including acceptable activities and groups). In accordance with community-based participatory research principles, we will engage with community experts in

Southern California and Alabama to interpret results and discuss ideas for multi-level feasible and acceptable interventions to increase positive social connections and reduce disparities among aging BSMM. This research is Stage 0-1 along the NIH Stage Model for Behavioral Intervention Development, in which we are collecting

basic data in order to generate ideas for intervention, which will be tested in future clinical trials. Information gained from this research will be broadly applicable to fostering healthy longevity for all aging Americans.