Understanding the influence of loneliness on HIV risk behaviors among a sample of young men who have sex with men (YMSM): A grounded theory approach

Background: There has been little research examining the influence of negative psychological states on HIV risk behaviors in YMSM (18-29 years). YMSM have been found to score higher on loneliness scales and be at higher risk for HIV acquisition compared to their heterosexual counterparts. Most studies that have addressed this topic have focused on the links between HIV risk behaviors and anxiety or depression. The influence of loneliness, however, is less understood. Methods: We used a grounded theory design and recruited 22 YMSM residing in Southern California for in-depth qualitative interviews. We utilized an inductive approach to explore the influence various forms of loneliness might have on HIV risk behavior in YMSM, and then produced a theoretical model grounded in the interview data. Results: Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged: negative symptoms, desire for temporary relief, perceived negative consequences related to engaging in HIV risk behaviors, and ultimately the reemergence of initial loneliness symptoms. Based on the common experiences and overlapping narratives of YMSM participants in our study, we developed the Model of Iterative Loneliness and HIV Risk Behavior in YMSM. Conclusions: Results suggest that loneliness in YMSM plays a greater role in HIV risk behavior than previously understood. YMSM engage in HIV risk behaviors to curb their desire for emotional and social connections with other YMSM. Our findings suggest the tailoring or development of behavioral and psychological interventions targeting YMSM both at the individual and group level.