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 Objectives 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. Design This study reports on findings from both an eligibility survey and baseline assessment for an online HIV risk reduction intervention. Participants There were 16,466 completed eligibility surveys. A total of 1205 eligible men completed a baseline assessment after consenting to participate in the intervention. Measurements and Results Among participants with a completed eligibility survey, those with an HIV-positive status had significantly worse sleep quality and more frequent use of sleep medications during the past month than did HIV-negative participants. Within the intervention sample (n=1205 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; 95% CI, 1.14-2.43), and who reported a detectable viral load in the past 6 months (AOR, 1.57; 95% CI, 1.06-2.33) had increased odds of poor sleep quality after controlling for demographic characteristics, socioeconomic status, antiretroviral therapy 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; 95% CI, 0.51-0.89). Conclusions 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 gay, bisexual, and other men who have sex with men living with HIV that promote protective factors and target particular behavioral changes (ie, stress reduction, substance use).