Heterogeneous longitudinal trajectories of sense of coherence and associated characteristics among newly diagnosed HIV-positive men who have sex with men: A cohort study.

objectiveThis study aimed to identify heterogeneous longitudinal trajectories of sense of coherence (SOC) among newly diagnosed HIV-positive men who have sex with men (MSM) and examine associated characteristics and factors across different trajectories.

methodsA prospective cohort study was conducted by recruiting newly diagnosed HIV-positive MSM from a tertiary hospital and a social work service center in Changsha, China. Follow-up surveys were administered at baseline (T1), 3 months (T2), and 6 months (T3). Data were collected on SOC, HIV stigma, perceived stress, depression, internalized homophobia, antiretroviral therapy (ART) adherence, comfort in accessing healthcare services, coping strategies, social support, and sociodemographic and sexual behavior characteristics. A latent class mixed model (LCMM) was fitted in R to identify SOC trajectories. Multinomial logistic regression was used to examine predictors of trajectory class membership, and psychosocial correlates of SOC were analyzed within each trajectory class.

resultsA total of 313 participants were included. Overall SOC declined significantly over the 6-month follow-up (F = 38.78, P < 0.001). LCMM identified four SOC trajectories: Continuously Low (13.10 %), Slow Decline (48.24 %), Rapid Decline (25.24 %), and Active Transition (13.42 %). Significant between-trajectory differences were observed in household registration (P = 0.016), educational level (P = 0.025), monthly income (P = 0.021), age at first sexual activity (H = 7.11, P = 0.041), and condom use during anal intercourse (P = 0.008). Using the Active Transition group as the reference, rural household registration increased the likelihood of belonging to the Slow Decline group (Coef = 1.02, P = 0.001). A lower educational level increased the likelihood of belonging to the Continuously Low group (Coef = -0.84, P = 0.026). Earlier age at first sexual activity (Coef = -0.24, P = 0.025) and a greater number of male partners (Coef = 0.37, P = 0.028) were associated with the Continuously Low group. Across trajectories, HIV stigma, perceived stress, and depression were negatively associated with SOC, with perceived stress showing a relatively stronger negative association. Social support was positively associated with SOC in the Continuously Low group (Coef = 0.78, P = 0.013). In the Slow Decline group, ART adherence (Coef = 0.76, P < 0.001) and comfort in accessing healthcare services (Coef = 0.88, P < 0.001) were positively associated with SOC.

conclusionSOC among newly diagnosed HIV-positive MSM declined significantly during the early post-diagnosis period and exhibited marked trajectory heterogeneity. Early trajectory-stratified interventions are warranted, particularly for the Continuously Low and Rapid Decline groups, to help sustain psychological resources and improve health outcomes.