Loneliness is a threat to the physical and emotional health of every member of our society. The former U.S. surgeon general, Vivek Murthy, reported that, for the general population, loneliness shortens lifespan as much as smoking 15 cigarettes a day. For persons living with HIV, especially those who are aging, such isolation can be catastrophic. Stigma, shame, physical pain, fear of discrimination or violence, and a host of other factors can push someone living with the virus to withdraw from their social circles with devastating health effects.
Multiple factors, including socioeconomics, physical and emotional status, and even technology, impact how we feel in terms of our connection and support from other people. Yet, a sense of isolation isn't always a direct reflection of reality. Feeling lonely is a subjective experience that can be influenced by one's perception, so it is just as easy to feel lonely in a crowd as when isolated at home.
Research Shows Loneliness Is a Problem for People With HIV
Rates of loneliness among people living with HIV are staggering: A cross-sectional study of clients at a San Francisco HIV health clinic found that 58% experienced loneliness (compared with an estimated 30% of the general population), 55% experienced depression, and 12% experienced post-traumatic stress disorder. The health impact of these conditions is significant. One recent study, for example, found that older persons living with HIV who reported being lonely experienced increased rates of depression and use of alcohol and tobacco. Another study of persons living with HIV found that loneliness, frequently caused by internalized stigma, impacted the quality of sleep, which itself had negative health consequences. And isolation creates more than emotional discomfort. Because the area of the brain that processes social exclusion is the same that processes physical pain, loneliness can have a real-world effect by amplifying the experience of body ache and increasing inflammation, which is particularly dangerous for someone living with HIV.
A great deal remains unknown about the effects of loneliness on various populations living with HIV. In one study, for example, older black adults with HIV reported less loneliness than did white adults, but isolation created a greater negative impact on cognitive function among blacks compared with whites. Older women living with HIV remain an understudied population in which the effects of aging, stigma, and sexism may combine to heighten both loneliness and its emotional and physical effects.
Related: Social Connectedness and HIV: Strategies for Better Health
How to Conquer Loneliness
A number of interventions are being investigated to impact loneliness and its consequences. Data suggest, for example, that efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health. And one trial intervention focusing on sexual health counseling among gay and bisexual men not only decreased rates of condomless sex but also had the unexpected outcome of creating significant reductions in two psychosocial outcomes, loneliness and sexual compulsivity.
Large-scale social phenomena like stigma and discrimination certainly impact an individual's sense of loneliness, but there are tools people can utilize not only to improve their perception of isolation but, in many cases, to actually increase their level of social involvement.
The technique of being consciously mindful of what one is observing, thinking and feeling has multiple benefits and, in particular, can be useful in altering the perception of isolation. When one is feeling lonely, the mind begins to ruminate, triggering negative feelings and, frequently, generating a sense of powerlessness and hopelessness. Memories of prior experiences of hurt and rejection can be triggered. While such negative thoughts are part of the human experience, a mindful approach encourages observing them, avoiding judgment, and letting them go. When one is being mindfully present (and not "lost" in the past or future), there is a sense of flow that is both engaging and empowering.
Connect With Community
The ability to create community by finding like-minded people can reduce the sense of loneliness and isolation. Sharing one's experiences with other persons living with HIV has the benefit of reducing the belief that one's feelings are unique and that no one could understand. There is no doubt that shame, stigma, and physical limitations impact one's ability to connect with community, but even home-bound individuals can improve their social networks through the use of technology. Persons living with HIV should take particular pride in our history of taking care of each other when few others would or could. It is important that we maintain this tradition and actively reach out to those who might be suffering in isolation.
The act of service to others is widely acknowledged to benefit not only the recipient but also the person carrying out such activities. Stigma and the emotional and physical consequences of HIV, especially for those with other stigmatized identities, such as aging or mental health concerns, can easily create a trap of isolation. Actively engaging with others and their needs can reset negative emotions and even soothe (or at least distract from) physical pain. In short, placing an emphasis on the well-being of others, if only for a brief period, can be a healing experience.
The digital age has produced incredible tools that can connect individuals regardless of geographic location and greatly assist physically challenged individuals in combatting isolation. Yet, an over-reliance on technology can actually create a profound sense of loneliness. As we spend more time in the digital space, there is a corresponding sense of societal loneliness. In my opinion, this is because digital communications, at least for the present, limit the benefit we gain from face-to-face interactions. They tend to be briefer, shallower, and overall less satisfying. While it seems paradoxical, I believe one remedy for loneliness is to put down one's phone and resume interacting directly with other people.
While someone living with HIV can employ many tools to combat loneliness, sometimes things can just be too overwhelming. Mental health professionals are trained to assist individuals that may find themselves uncertain or unable to find their own way out of an emotional concern. In my opinion, because of the intense emotional and physical stress of living with HIV, every person who does could and should, at some point, benefit from working with a psychotherapist. The mental health workforce is increasingly familiar with, and competent to treat, psychological issues common to people who are HIV positive.
For persons living with HIV, loneliness not only can devastate quality of life but also can threaten health outcomes. Researchers continue to gain insight into how we can combat isolation among specific populations but, in the meantime, we can confront such isolation both as individuals and as a community.