title: Engagement in Care, Psychological Distress, and Resilience are Associated with Sleep Quality among HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men.
abstract: We investigated risk and protective factors associated with sleep quality among a national sample of HIV-positive gay, bisexual, and other men who have sex with men (GBMSM).
  
  
  
  This study reports on findings from both an eligibility survey and baseline assessment for an online HIV risk reduction intervention.
  
  
  
  There were 16,466 completed eligibility surveys. A total of 1,205 eligible men completed a baseline assessment after consenting to participate in the intervention.
  
  
  
  Among participants with a completed eligibility survey, men with an HIV-positive status had significantly worse sleep quality and more frequent use of sleep medications during the past month than HIV-negative men. Within the intervention sample (n = 1,205 HIV-positive participants), men with symptoms of anxiety (Adjusted odds ratio [AOR]=2.80; 95% confidence interval [CI]: 1.93-4.06) and depression (AOR=1.66; CI: 1.14-2.43), and who reported a detectable viral load in the past six months (AOR=1.57; CI: 1.06-2.33) had increased odds of poor sleep quality after controlling for demographic characteristics, socioeconomic status, ART use and adherence, substance use, and CD4 count. However, men with greater perceived resilience had decreased odds of reporting poor sleep quality during the past month (AOR=0.68; CI: 0.51-0.89).
  
  
  
  Findings from this online study call for more attention to the role of sleep in immune system functioning and engagement in HIV care. Results further suggest a need to design and test culturally-appropriate sleep health interventions for GBMSM living with HIV that promote protective factors and target particular behavioral changes (i.e., stress reduction, substance use).
authors.affiliation: Public Health Solutions, New York, NY. Electronic address: mdowning@healthsolutions.org.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Downing
authors.affiliation: Public Health Solutions, New York, NY.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Houang
authors.affiliation: Public Health Solutions, New York, NY.
authors.forename: Roberta
authors.initials: R
authors.lastname: Scheinmann
authors.affiliation: Public Health Solutions, New York, NY.
authors.forename: Irene S
authors.initials: IS
authors.lastname: Yoon
authors.affiliation: Public Health Solutions, New York, NY.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Chiasson
authors.affiliation: Public Health Solutions, New York, NY.
authors.forename: Sabina
authors.initials: S
authors.lastname: Hirshfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001727:Bisexuality / Q000523:psychology*; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological; D012890:Sleep / Q000502:physiology*; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
keywords: HIV; gay and bisexual men; psychological distress; resilience; sleep quality