The social cure effects of United Voices: a randomized waitlist-controlled pilot trial of an online group-singing intervention for older adults with HIV

Introduction Older adults with HIV experience increasing loneliness and social isolation as they age with the stigma of HIV. Group singing is a promising social identity approach but remains largely understudied among people with stigmatizing health conditions. Based on our conceptual model, we developed United Voices (UV), a group-singing intervention for older adults with HIV to mitigate the impacts of stigma on loneliness and social isolation. Methods We conducted a randomized, waitlist-controlled pilot trial of UV to evaluate its feasibility and acceptability. A total of 23 people with HIV ages 50 years and older were randomized into immediate- (n=13) or delayed-start (n=10) group of 12 weekly 90-minute group-singing sessions via Zoom during COVID-19. Psychosocial and behavioral measures were administered at baseline, 6- and 12-weeks, and semi-structured exit interviews were conducted. Results Of four a priori feasibility thresholds, only enrollment was met (6.8 per week vs. 6). Of 27 enrolled participants, 23 (85%) were randomized (threshold 100%). Of 13 randomized to the immediate-start arm, 9 (69.2%) completed baseline (threshold 80%); of these, 7 (77.8%) attended at least 10 of 12 rehearsals and 7 (77.8%) completed both follow-up assessments (thresholds 80%). Among the 7 participants who completed the acceptability survey, the 80% benchmark was met for staff support (100%), information provided, the study website, rehearsal structure, and confidence in ability to participate (86% each), but not for overall satisfaction with the choir (71%) or the research study (57%). Exit interviews from 4 of the 13 participants randomized to the immediate-start arm indicated that while participants were at first skeptical regarding online group-singing, the experience was enjoyable, providing a social outlet during shelter-in-place. Discussion Participants appreciated getting to know and supporting each other over time. The professionally rendered concert recording was a source of pride. Interviewed participants described pride, belonging, and mutual support, consistent with the social identity processes UV is designed to engage; whether these processes reduce loneliness and social isolation remains to be tested. Findings identify the procedural changes needed before a full-scale randomized controlled trial to test the efficacy of UV among older adults with HIV.