Bridge to Belonging: Peer Led Intervention to Reduce Loneliness and Depression Among Older Gay and Bisexual Men

Overview

Older gay and bisexual men living with HIV (OGBMLH) are more likely to experience depression and loneliness, which can lead to negative health outcomes. This mixed-methods research study will assess the feasibility and acceptability of the Bridge to Belonging (B2B) intervention. B2B is a peer-delivered, manualized program designed to increase engagement in LGBTQ+-affirming elder services and thereby reduce loneliness and depression among OGBMLH. The program utilizes a) cognitive behavioral therapy-based Friendship Enrichment Program (FEP) to build social skills; b) Peer Mentoring (PM) to model and support engagement in community services; and c) connecting participants to affirming elder services such as meal programs, bereavement groups, social activities, etc. Interventions like B2B are essential to the NIH's goal of improving access to behavioral interventions through advances in HIV/AIDS research.

Among older gay and bisexual men living with HIV (OGBMLH), depression and loneliness are significantly more prevalent than among their heterosexual and HIV-negative peers. These elevated rates are driven in part by intersectional stigma (e.g. from age, HIV status, sexual orientation, etc.) and social isolation and/or family rejection. As a result, OGBMLH who experience depression and/or loneliness are more likely to experience cognitive decline, increased morbidity and mortality, and decreased overall quality of life. LGBTQ+-affirming community services for elders offer a promising avenue for providing socialization, many OGBMLH do not access these resources, likely due to anticipated discrimination and structural barriers to care. Interventions are needed to address these barriers so that OGBMLH can connect and engage with affirming community services, thereby building social support and reducing their depression and loneliness. Guided by the ADAPT-ITT model, we developed and refined the Bridge to Belonging (B2B) intervention through two formative aims: focus group discussions with OGBMLH (Aim 1) and community experts and elder service providers (Aim 2). This process led to the B2B intervention, which is a peer-delivered, manualized program designed to increase engagement in LGBTQ+-affirming community services as a way to reduce depression and loneliness among OGBMLH. B2B aims to foster this engagement by utilizing a) a cognitive behavioral therapy-based Friendship Enrichment Program to build social skills; b) Peer Mentoring to model and support engagement in community services; and c) connecting participants to affirming elder services including meal programs, support groups, and social activities. The current study will conduct a proof-of-concept pilot (Aim 3; N=40) to assess the primary outcomes of feasibility (e.g. recruitment, delivery, retention rates, etc.). and acceptability (e.g. quantitative satisfaction measures and qualitative exit interviews of participants) of the B2B intervention. The study will assess pre-to-post changes in depression (PHQ-9), loneliness (UCLA Loneliness Scale), instrumental activities of daily living (OARS), antiretroviral adherence (Wilson's), HIV viral load, and quality of life (QOLS). Should the intervention demonstrate adequate feasibility and acceptability, and the hypothesized pathway of increasing engagement with affirming community services as a mechanism to reduce depression and loneliness be supported, we will be well-positioned to conduct a fully powered efficacy trial to assess B2B's scalability as a community-integrated behavioral health intervention for OGBMLH.