Exploring relationship among sTRess, Isolation, and Physical activity (TRIP) in older adults living with HIV/AIDS (PLWH)


With the development and global scale-up of HIV anti-retroviral therapy over the past 15 years, life expectancy for persons living with HIV/AIDS (PLWH) has increased dramatically. Consequently, morbidity and mortality from non-AIDS defining complications such as cardiovascular disease, cancer and neurological health conditions has also risen.

These chronic co-morbidities, as well as HIV disease progression, might be linked to increased stress and isolation in PLWH. There are related behaviors (physical activity, social activities, sleep hygiene) that can be modified through educational, societal and biomedical interventions, to decrease this stress and potentially slow the development of non-AIDS defining complications.

This exploratory study will help to identify these modifiable psychosocial risk factors in older PLWH and this work may lead to development of novel evidence-based stress reduction interventions for this population.

Therefore the specific aims of this project are:

  1. To describe and compare levels of stress, isolation, and physical activity between older HIV+ adults (>51 years of age) and younger HIV+ adults (18-50 years).
  2. To describe and compare differences in levels of stress, isolation, and physical activity between men and women living with HIV/AIDS.

Research Design

The study design is a descriptive longitudinal study with four age- and gender-stratified group: 160 HIV+ adults in Northeast Ohio; 80 adults 18-50 years of age; 80 adults > 51 years of age;

  • Group 1: 40 HIV+ women 18-50 years of age;
  • Group 2: 40 HIV+ men 18-50 years of age;
  • Group 3: 40 HIV +women> 51 years of age; and
  • Group 4: 40 HIV+ men > 51 years of age

All subjects completed baseline assessments of stress (psychometric scales, heart rate variability, and serum biomarkers) and isolation, as well as wrist actigraphy; 24-hour nutrition assessments; and sleep, medication adherence, and physical activity diaries. Subjects also completed additional physiological assessment, psychometric scales, and consented to chart abstraction to assess covariates. Follow up assessments were made approximately 1 year after the baseline assessment. Annual follow-up is planned.


Data analysis from waves 1 and 2 is ongoing. Published results can be found in the documents below.

Research Team

Principal Investigator:

  • Allison R. Webel, RN, PhD, Frances Payne Bolton School of Nursing, Case Western Reserve University


  • Jan E. Hanson, MPH, University Hospitals Case Medical Center, Comprehensive Cancer Center
  • Chris T. Longenecker, MD, University Hospitals Case Medical Center; Harrington Heart and Vascular Institute
  • Robert A. Salata, MD, University Hospitals Case Medical Center; Case Western Reserve University School of Medicine

Research Publications

Webel, A. R., Perazzo, J., Decker, M., Horvat-Davey, C., Sattar, A. and Voss, J. (2016), Physical activity is Associated with Reduced Fatigue in Adults Living with HIV/AIDS. J Adv Nurs. Accepted Author Manuscript. doi:10.1111/jan.13084

Perazzo, J.,Webel, A. Alcohol use and HIV self-management. (2016) Journal of the Association of Nurses in AIDS Care. (In press)

Webel, A.R., Sattar, A, Schriener, N., Kinley, B., Moore, SM. & Salata, RA. (2016) The Impact of Mental Wellness on HIV Self-Management.  Journal of the Association of Nurses in AIDS Care. 27 (4) 468-75.

Webel, A.R., Sattar, A. Schreiner, N. & Phillips, J.C. (2016). Social Resources, Health Promotion Behavior, and Quality of Life in Adults Living with HIV Disease. Applied Nursing Research 30, 204-209. NIHMS 714054

Webel, A.R., Barkley, J.E., Longenecker, C.T., Mittlelsteadt, A., Gripshover, B., Salata, R.A. (2015). A Cross-Sectional Description of Age and Gender Differences in Exercise Patterns in Adults Living With HIV. Journal of the Association of Nurses in AIDS Care. 26(2) 176-186 PMCID PMC4284137

Webel, A.R. Longenecker, C.T., Gripshover, B., Hanson, J.E., Schmotzer, B.J. & Salata, R.A. (2013). Age, stress, and isolation in older adults living with HIV. AIDS Care. 1-9

Research Presentations

NINR 30th Anniversary Poster Presentation (PDF)

Webel AR., Sattar A, Longenecker, CT, Schreiner N, Josephson, R. (2015). The relationship between Lifestyle factors and Cardiovascular Disease Risk in HIV+ Adults (PDF). AHA Epidemiology/Lifestyle Scientific Sessions. March 5. Baltimore, MD. Poster Presentation (P232)

Webel, AR., Longencker, CT., Hanson, JE. & Salata, R. Exploring differences in sTRess, Isolation, Physical activity and sleep (TRIP) in older and younger adults living with HIV (PLWH) (PDF). Council on the Advancement of Nursing Science, Washington, DC. Poster Presentation


This study was supported by funds from the National Institutes of Health (5 KL2 TR000440, 1UL1 RR024989, & P30 NR010676) in the United States.