Psychosocial factors associated with patient activation among men who have sex with men living with HIV in Nanjing, China: a single-center cross-sectional study

With the widespread use of antiretroviral therapy (ART), HIV infection has gradually become a chronic condition requiring long-term management. Patient activation plays an important role in promoting effective self-management and improving health outcomes among people living with HIV. However, limited evidence exists regarding patient activation and its psychosocial determinants among men who have sex with men (MSM) living with HIV in China. This study aimed to investigate the level of patient activation and explore its associated psychosocial factors in this population. A single-center cross-sectional study was conducted using convenience sampling. A total of 303 MSM living with HIV attending the Department of Infectious Diseases at the Second Hospital of Nanjing between December 2025 and February 2026 were recruited. Data were collected using a General Information Questionnaire, the Patient Activation Measure-13 (PAM-13), the Berger HIV Stigma Scale-12 (BHSS-12), the Connor–Davidson Resilience Scale (CD-RISC), and the Social Support Rating Scale (SSRS). Pearson correlation analysis, univariate analysis, and hierarchical multiple linear regression analysis were performed to examine factors associated with patient activation. The mean patient activation score among MSM living with HIV was 55.68 ± 9.62, corresponding to Level 3, and indicating a moderate-to-high level of activation. Pearson correlation analysis showed that patient activation was negatively correlated with HIV-related stigma ( r = − 0.553, P < 0.01) and positively correlated with psychological resilience ( r = 0.495, P < 0.01) and social support ( r = 0.544, P < 0.01). Hierarchical multiple linear regression analysis indicated that duration since HIV diagnosis, number of comorbidities, disclosure of HIV status to others, HIV-related stigma, psychological resilience, and social support were significantly associated with patient activation (all P < 0.05). The final model explained 60.5% of the variance in patient activation. Patient activation among MSM living with HIV was significantly associated with several psychosocial factors, including HIV-related stigma, psychological resilience, and social support. These findings suggest that psychosocial factors may be important considerations in understanding patient activation among MSM living with HIV.