Family relationships, perceived stigma, and social isolation among people living with HIV/AIDS: a cross-sectional study in China

Social isolation is a critical determinant of health that disproportionately affects people living with HIV/AIDS (PLWHA). Although existing literature has identified associations of family relationships and perceived stigma with social isolation, the ways in which these factors are statistically related remain insufficiently explored. This study aimed to assess the level of social isolation among PLWHA in China and to examine whether perceived stigma is statistically associated with the relationship between family relationships and social isolation. A cross-sectional study was conducted among 294 PLWHA recruited through convenience sampling from Chengdu Public Health Clinical Center and the Xichang Center for Disease Control and Prevention between March 2023 and July 2024. Participants completed questionnaires on sociodemographic variables, disease-related information, General Alienation Scale, Berger HIV Stigma Scale, and Family Intimacy and Adaptability Scale. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation, and Bootstrap mediation analysis (PROCESS Model 4) in SPSS 27.0. A total of 294 PLWHA (78.9% male; mean age 42.31 years) were included in the analysis. Participants reported relatively high levels of social isolation (mean = 41.46 ± 7.25). Family relationships were negatively associated with perceived stigma (r = − 0.300, p < 0.01) and social isolation (r = − 0.623, p < 0.01), while perceived stigma was positively associated with social isolation (r = 0.478, p < 0.01). Mediation analysis indicated that perceived stigma was statistically associated with the relationship between family relationships and social isolation (indirect association = − 0.033, 95% CI [− 0.051, − 0.018]), accounting for 15.1% of the total association. Social isolation remains a prominent concern among PLWHA. Family relationships are associated with lower levels of social isolation, and this association is partially linked to perceived stigma. These findings highlight the potential importance of addressing both family support and perceived stigma in future research and intervention development. However, given the cross-sectional design, the findings should be interpreted as associational rather than causal.