Psychosocial Factors Associated with Patient Activation among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study

Psychosocial Factors Associated with Patient Activation among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial Factors Associated with Patient Activation among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study Rui Huang, Mengya Wang, Yuhan Wu, Wenwen Yang, Yan Song This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9081397/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background 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. Methods A 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, the Berger HIV stigma scale-12, the Connor–Davidson Resilience Scale, and the Social Support Rating Scale. Pearson correlation analysis, univariate analysis, and multiple linear regression analysis were performed to identify factors associated with patient activation. Results The mean patient activation score among MSM living with HIV was 55.68 ± 9.62. Pearson correlation analysis showed that patient activation was negatively correlated with perceived discrimination ( 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). Multiple linear regression analysis indicated that duration since HIV diagnosis, number of comorbidities, disclosure of HIV status to others, perceived discrimination, psychological resilience, and social support were significant predictors of patient activation (all P < 0.05), explaining 55.3% of the total variance. Conclusion Patient activation among MSM living with HIV is influenced by multiple psychosocial factors. Interventions aimed at reducing perceived discrimination and enhancing psychological resilience and social support may help improve patient activation and promote effective self-management among MSM living with HIV. HIV men who have sex with men patient activation perceived discrimination psychological resilience social support Introduction Acquired immunodeficiency syndrome (AIDS) is a chronic infectious disease caused by the human immunodeficiency virus (HIV) and remains a major global public health challenge. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), approximately 40.8 million people worldwide were living with HIV/AIDS by the end of 2024 [ 1 ]. In China, about 1.35 million people were living with HIV/AIDS by the end of 2024, with 102,000 newly reported cases in that year. Sexual transmission is the predominant route of infection, with male-to-male sexual transmission accounting for more than one quarter of cases [ 2 ]. Men who have sex with men (MSM) are a key population at high risk for HIV infection in China, with a substantially higher infection risk than the general population [ 3 ]. Compared with other people living with HIV, MSM living with HIV present several unique characteristics. First, this population often faces intersectional stigma related to both HIV status and sexual minority identity, which may lead to discrimination and social exclusion [ 4 ]. Studies have shown that the prevalence of depression among MSM living with HIV is significantly higher than that in the general population [ 5 , 6 ]. Second, fear of HIV status disclosure is common among MSM. Concerns about discrimination may lead some individuals to conceal their status or delay seeking medical care, which may negatively affect disease management [ 7 ]. Therefore, focusing on MSM living with HIV and exploring their health management issues in depth is of great importance for improving health outcomes and contributing to HIV prevention efforts. With the widespread use of antiretroviral therapy (ART), the life expectancy of people living with HIV has significantly increased [ 8 ]. HIV infection has gradually been transformed into a chronic condition requiring long-term management [ 9 ]. In this context, the role of patients in disease management has become increasingly important. They are required to maintain long-term medication adherence, monitor disease progression, manage symptoms, and sustain healthy lifestyle behaviors. Patient activation refers to the knowledge, skills, confidence, and beliefs that individuals possess in managing their own health [ 10 ], and it is considered an important factor in promoting effective self-management [ 11 ]. Studies have shown that patient activation plays a significant role in improving health outcomes among individuals with chronic diseases and is an important predictor of health behaviors [ 12 , 13 ]. For MSM living with HIV, maintaining and enhancing patient activation is particularly important due to lifelong ART, medication side effects, and psychosocial pressures. Although patient activation has received increasing attention in recent years, most studies in China have focused on populations with chronic non-communicable diseases such as diabetes and cancer. However, little is known about how psychosocial factors such as perceived discrimination, psychological resilience, and social support are associated with patient activation among MSM living with HIV in China. From a psychosocial perspective, these factors are hypothesized to play a critical role in shaping individuals' motivation, confidence, and ability to engage in health self-management. Therefore, this study conducted a cross-sectional survey to examine patient activation among MSM living with HIV. The study analyzed the influence of demographic and disease-related characteristics and explored the associations between perceived discrimination, psychological resilience, social support, and patient activation. The aim of this study was to identify factors associated with patient activation among MSM living with HIV and to inform targeted psychosocial interventions to enhance patient activation in clinical practice. Methods Study design and setting This cross-sectional study was conducted among MSM living with HIV who attended the Department of Infectious Diseases at Nanjing Second Hospital, a designated hospital for HIV/AIDS treatment in Nanjing, China. Participants were recruited between December 2025 and February 2026. Selection of Participants and sample size Participants were recruited using a convenience sampling method and included MSM living with HIV who met the inclusion and exclusion criteria. The inclusion criteria were: (1) aged ≥18 years; (2) previously diagnosed with HIV; (3) self-reported HIV transmission through male-to-male sexual behavior; (4) provided informed consent and voluntarily agreed to participate in the study. The exclusion criteria were: (1) severe cognitive impairment or psychiatric disorders; (2) presence of severe somatic diseases. A total of 24 variables were considered in this study. The required sample size was estimated to be 5–10 times the number of variables [14]. Assuming a 20% invalid response rate, a minimum sample size of 150–300 participants was required. A total of 311 questionnaires were distributed, and 303 valid responses were obtained, yielding a response rate of 97.43%. Instruments General Information Questionnaire The questionnaire was self-developed by the researchers based on a literature review and included items on age, residence, marital status, educational level, employment status, monthly income, Medical expense payment way, duration since HIV diagnosis, number of comorbidities, and disclosure of HIV status to others. Patient Activation Measure-13 (PAM-13) The PAM-13 was developed and revised by Judith H. Hibbard et al. [15]. It consists of 13 items covering four dimensions: cognition, skill, action, and belief. Each item is rated on a 4-point Likert scale ranging from "strongly disagree" to "strongly agree," scored from 1 to 4, with "not applicable" scored as 0. The raw score is calculated as the sum of all item scores and is subsequently converted into a standardized patient activation score on a 0–100 scale using the scoring conversion algorithm authorized by Insignia Health. Based on the standardized score, patient activation is categorized into four levels: level 1 (≤47.0), level 2 (47.1–55.1), level 3 (55.2–67.0), and level 4 (≥67.1), with higher scores indicating higher levels of patient activation [16]. In this study, the Cronbach's α coefficient of the scale was 0.847, and the KMO value was 0.783, indicating good reliability and validity. Berger HIV stigma scale-12 (BHSS-12) The BHSS-12 was revised by Marcus E. Reinius et al. [17]. It consists of 12 items across four dimensions: personalised stigma, disclosure concerns, concerns about public attitudes, and negative self-image. Each item is rated on a 4-point Likert scale ranging from "strongly disagree" to "strongly agree," scored from 1 to 4. The total score is calculated as the sum of all item scores, ranging from 12 to 48. Based on previous literature [18], participants were categorized into three levels of perceived discrimination—none or mild, moderate, and severe—according to the 33rd and 66th percentiles of the scale scores in the study population. In this study, the Cronbach's α coefficient of the scale was 0.861, and the KMO value was 0.832, indicating good reliability and validity. Connor-Davidson Resilience Scale (CD-RISC) The CD-RISC was developed by Connor and Davidson [19] and later revised for the Chinese population by Xiao N et al. [20]. The scale consists of 25 items across three dimensions: optimism, strength, and tenacity. Each item is rated on a 5-point Likert scale ranging from "not true at all" to "true nearly all the time," scored from 0 to 4. The total score is calculated as the sum of all items, ranging from 0 to 100, with higher scores indicating greater psychological resilience. In this study, the Cronbach's α coefficient of the scale was 0.897, and the KMO value was 0.912, indicating good reliability and validity. Social Support Rating Scale (SSRS) The SSRS was developed by Xiao S [21] to assess the level of social support. The scale consists of 10 items across three dimensions: subjective support, objective support, and utilization of social support, with a total possible score of 66. The total score is calculated as the sum of all item scores, with higher scores indicating better social support. According to the total score, social support is categorized into three levels: low (22), moderate (22–44), and high (45–66). In this study, the Cronbach's α coefficient of the scale was 0.802, and the KMO value was 0.844, indicating good reliability and validity. Data collection procedures Data were collected by two nursing postgraduate students who received standardized training prior to the study. Participants were informed of the study purpose, questionnaire requirements, and confidentiality principles using standardized instructions. After providing informed consent, participants completed paper questionnaires on site. Questionnaires were collected immediately and checked for completeness, with any missing items promptly supplemented. Data analysis Data were analyzed using SPSS version 26.0. Categorical variables were presented as frequencies (n) and percentages (%), and continuous variables with a normal distribution were presented as mean ± standard deviation (SD). Independent-samples t-tests and one-way analysis of variance (ANOVA) were used to compare differences between groups. Pearson correlation analysis was performed to examine associations between variables, and multiple linear regression analysis was used to identify factors influencing patient activation. A two-tailed P < 0.05 was considered statistically significant. Since data were collected via self-reported questionnaires, common method bias (CMB) could affect the study validity. Therefore, Harman's single-factor test was conducted. The results showed that 15 factors had eigenvalues greater than 1, and the first factor accounted for 22.79% of the total variance, which is below the critical threshold of 40%. Therefore, there was no serious common method bias in the data. The ethical considerations This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Approval No. 2025-LS-ky120). Written informed consent was obtained from all participants prior to data collection. Results Participant characteristics The mean age of the 303 participants was 37.96 ± 10.46 years. Among them, 216 (71.29%) were unmarried, 62 (20.46%) were married, 24 (7.92%) were divorced, and 1 (0.33%) was widowed. Detailed information is presented in Table 1. Table 1 Characteristics of participants (n=303) Characteristics Frequency (n) Percentage (%) Age (years) 18-＜30 66 21.78 30-＜40 129 42.57 40-＜50 62 20.46 ≥50 46 15.18 Residence Urban 214 70.63 Rural 89 29.37 Marital status Unmarried 216 71.29 Married 62 20.46 Divorced 24 7.92 Widowed 1 0.33 Educational level Primary school or below 2 0.60 Junior high school 43 14.19 Senior high school or technical secondary school 50 16.50 Junior college 97 32.01 Bachelor's degree or above 111 36.63 Employment status Employed 264 87.13 Retired 18 5.94 Unemployed 12 3.96 Student 9 2.97 Monthly income (CNY) ＜1000 7 2.31 1000-＜3000 23 7.59 3000-＜5000 21 6.93 ≥5000 252 83.17 Medical expense payment way Medical insurance for urban employees 210 69.31 Medical insurance for urban and rural residents 27 8.91 Self-paid 64 21.12 Other 2 0.66 Duration since HIV diagnosis (years) ＜1 23 7.59 1-＜5 83 27.39 5-＜9 86 28.38 ≥9 111 36.63 Number of comorbidities 0 172 56.77 1 87 28.71 2 30 9.90 ≥3 14 4.62 Disclosure of HIV status to others Yes 219 72.28 No 84 27.72 Scores of patient activation, perceived discrimination, psychological resilience, and social support among MSM living with HIV The patient activation score among MSM living with HIV was 55.68 ± 9.62. The scores for perceived discrimination, psychological resilience, and social support were 33.19 ± 4.56, 63.26 ± 10.20, and 34.32 ± 7.64, respectively. The scores of each dimension of patient activation are presented in Table 2. Table 2 Scores of each dimension of patient activation among MSM living with HIV (n=303) Dimensions Items (n) Score ( ± s) Mean item score ( ± s) Belief 2 5.27±1.26 2.63±0.63 Cognition 2 6.91±1.02 3.46±0.51 Behavior 3 8.55±1.33 2.85±0.44 Skill 6 17.29±2.43 2.88±0.40 Univariate analysis of patient activation among MSM living with HIV The results of the univariate analysis showed that patient activation levels differed significantly among MSM living with HIV with different durations since HIV diagnosis, numbers of comorbidities, and disclosure of HIV status to others ( P < 0.05). The results are shown in Table 3. Table 3 Comparison of patient activation scores among MSM living with HIV (n=303) Variables patient activation ( ±s) t/F -value P -value Age (years) 0.599 0.616 18-＜30 56.13±10.54 30-＜40 56.08±9.01 40-＜50 55.65±10.47 ≥50 53.98±8.81 Residence 1.175 0.241 Urban 56.10±10.00 Rural 54.68±8.62 Martial status 2.426 0.066 Unmarried 56.30±9.64 Married 53.37±9.93 Divorced 56.77±7.55 Widowed 40.70±0.00 Educational level 1.62 0.169 Primary school or below 52.55±7.85 Junior high school 54.69±8.52 Senior high school or technical secondary school 53.71±9.31 Junior college 55.26±9.26 Bachelor's degree or above 57.39±10.35 Employment status 0.321 0.810 Employed 55.63±9.70 Retired 56.57±8.09 Unemployed 57.30±8.83 Student 53.49±11.90 Monthly income (CNY) 1.415 0.238 ＜1000 52.43±3.82 1000-＜3000 52.56±9.12 3000-＜5000 54.41±10.90 ≥5000 56.17±9.63 Medical expense payment way 1.143 0.332 Medical insurance for urban employees 56.33±9.36 Medical insurance for urban and rural residents 55.08±9.49 Self-paid 53.93±10.02 Other 52.20±25.46 Duration since HIV diagnosis (years) 5.072 a 0.003 ＜1 48.46±9.81 1-＜5 56.68±11.64 5-＜9 55.28±9.21 ≥9 56.75±7.44 Number of comorbidities 4.557 0.004 0 56.70±9.33 1 56.10±9.59 2 51.21±8.29 ≥3 50.15±12.26 Disclosure of HIV status to others 4.667 ＜0.001 Yes 57.23±9.34 No 51.66±9.23 Note: a indicates the F -value obtained from the Welch test when the assumption of homogeneity of variance was not met. Correlation analysis of patient activation with perceived discrimination, psychological resilience, and social support among MSM living with HIV Pearson correlation analysis showed that patient activation was negatively correlated with perceived discrimination ( 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) among MSM living with HIV. The results are shown in Table 4. Table 4 Correlation analysis among variables (r-value, n = 303) Variables patient activation Perceived discrimination psychological resilience Social support patient activation 1 Perceived discrimination -0.553** 1 psychological resilience 0.495** -0.424** 1 Social support 0.544** -0.326** 0.246** 1 Note: ** P < 0.01 Multivariate analysis of patient activation among MSM living with HIV Patient activation total score was set as the dependent variable, and variables that were significant in the univariate analysis, along with perceived discrimination, psychological resilience, and social support, were included as independent variables in a multiple linear regression analysis. The variance inflation factors (VIF) ranged from 1.004 to 1.401 (0.1, indicating no multicollinearity. The coding of independent variables is shown in Table 5. The results indicated that duration since HIV diagnosis, number of comorbidities, disclosure of HIV status to others, perceived discrimination, psychological resilience, and social support were all significant predictors of patient activation (all P < 0.05), explaining 55.3% of the total variance (Table 6). Table 5 Coding of independent variables Independent variables Coding Duration since HIV diagnosis (years) ＜1=1, 1-＜5=2, 5-＜9=3, ≥9=4 Number of comorbidities 0=1, 1=2, 2=3, ≥3=4 Disclosure of HIV status to others Yes=1, No=2 Perceived discrimination Original score Psychological resilience Original score Social support Original score Table 6 Multiple linear regression analysis of patient activation (n = 303) Variables B SE β t P TOL VIF Duration since HIV diagnosis (years) 0.901 0.389 0.091 2.318 0.021 0.960 1.042 Number of comorbidities -2.188 0.439 -0.192 -4.978 ＜0.001 0.996 1.004 Disclosure of HIV status to others -2.031 0.872 -0.095 -2.330 0.020 0.897 1.115 Perceived discrimination -0.600 0.096 -0.284 -6.248 ＜0.001 0.714 1.401 Psychological resilience 0.257 0.041 0.272 6.257 ＜0.001 0.782 1.279 Social support 0.457 0.052 0.362 8.777 ＜0.001 0.868 1.152 Note: R² =0.562, Adjusted R² =0.553, F =63.278, P <0.001 Discussion Patient activation among MSM living with HIV was at a moderately high level The study found that the level of patient activation among MSM living with HIV was moderately high. According to the grading criteria of the PAM, the total score corresponded to level 3 [16]. At this level, patients are prepared to take self-management actions but still lack sufficient skills and confidence to sustain these behaviors. This result was lower than that reported by Chapman Lambert et al. among young Black women living with HIV [22]. This discrepancy may be attributed to differences in study populations, sociocultural contexts, and psychosocial resources. The mean scores in the belief dimension were relatively low, suggesting that some MSM living with HIV lacked confidence in coping with disease-related challenges and maintaining healthy behaviors. This may be associated with HIV-related stigma, societal prejudice toward sexual minorities, the psychological burden of chronic disease, and insufficient social acceptance. The mean scores in the behavior dimension were at a moderate level, suggesting that some patients may face difficulties translating health knowledge into practice. Therefore, healthcare providers should place greater emphasis on assessing patient activation among MSM living with HIV. Targeted interventions, such as psychological and peer support, may help strengthen patients' confidence in coping with the disease and enhance their engagement in self-management [23]. Influencing factors of patient activation among MSM living with HIV Duration since HIV diagnosis The findings suggest that duration since HIV diagnosis was an important factor associated with patient activation ( β =0.091, P <0.05). Patients with a shorter duration since HIV diagnosis exhibited lower levels of patient activation, which is consistent with the findings reported by Barnes et al. [24]. This may be because MSM in the early stage after HIV diagnosis may not yet have fully accepted their infection status and often experience negative emotional reactions, such as denial, anger, and depression [25]. In addition, the psychological burden associated with HIV-related stigma may lead some patients to conceal their infection status or avoid seeking necessary medical support [7]. Moreover, patients at this stage may have limited awareness of HIV and the importance of ART. In the absence of an established follow-up system or clear feedback regarding treatment outcomes, they may find it difficult to perceive the benefits of treatment, which may ultimately reduce their motivation for self-management [25]. These findings suggest that healthcare providers should pay particular attention to MSM in the early stage after HIV diagnosis. Timely psychological counseling and individualized health education should be provided to help patients develop an accurate understanding of HIV and accept their health status, thereby improving patient activation and treatment adherence [26]. Number of comorbidities The results showed that patients with a higher number of comorbidities tended to have lower levels of patient activation ( β =-0.192, P <0.001). This may be because multiple comorbidities increase the burden of health management. With an increasing number of comorbidities and longer disease duration, patients may experience repeated challenges in long-term disease management, potentially leading to frustration and ultimately reducing their motivation for self-management [27]. Therefore, in clinical practice, healthcare providers should pay particular attention to MSM living with HIV with a higher number of comorbidities and offer comprehensive disease management support. Integrating healthcare resources and establishing multidisciplinary teams to provide one-stop healthcare services may help reduce patients' healthcare burden and enhance their engagement in self-management [28]. Disclosure of HIV status The study found that disclosure of HIV status to others was a protective factor for patient activation among MSM living with HIV ( β =-0.095, P <0.05). Those who disclosed their HIV status demonstrated higher levels of patient activation compared with those who did not. Disclosing HIV status to trusted partners, family members, or friends may enable MSM living with HIV to obtain emotional and practical support, which can help alleviate social isolation and facilitate acceptance of their health status [29]. Furthermore, such support may mitigate the psychological burden associated with the dual stigma of HIV and sexual minority status, reduce the need to hide their HIV status, and ultimately enhance patients' confidence and motivation to engage in health management behaviors [30, 31]. Disclosure of HIV status is influenced by multiple factors. In clinical practice, healthcare providers should fully respect patients' autonomy in disclosure decisions. Disclosure counseling should be provided at key time points, such as shortly after diagnosis and during follow-up visits, to help patients identify appropriate disclosure targets and develop effective communication strategies, thereby enhancing the positive effects of disclosure while minimizing potential negative consequences [32]. In addition, healthcare providers should also recognize differences in patients' motivations for disclosure, provide targeted support to address the psychological and social challenges they may face, and help patients develop individualized disclosure strategies [31]. Perceived discrimination Perceived discrimination was an important influencing factor of patient activation among MSM living with HIV ( β =-0.284, P <0.001). Higher levels of perceived discrimination were associated with lower levels of patient activation, which is consistent with previous studies [33]. In this study, MSM living with HIV reported a moderate level of perceived discrimination, suggesting that perceived discrimination remains prevalent in this population. This may stem from the overlapping stigma associated with both sexual minority identity and HIV infection [33]. Traditional Chinese cultural values emphasizing heterosexual marriage and continuation of the family lineage may further intensify the prejudice they face within families and society [34-35]. To avoid social rejection, MSM living with HIV may conceal their HIV status and avoid necessary healthcare services, which may contribute to lower levels of patient activation [7]. Persistent negative social feedback may gradually influence patients' self-perception, resulting in psychological distress and self-stigma. These psychological responses may foster a negative self-image and feelings of low self-worth, thereby weakening their motivation to maintain healthy behaviors [36]. Given the negative impact of perceived discrimination on patient activation among MSM living with HIV, multilevel interventions are needed to mitigate its adverse effects. At the individual level, discrimination-related training can be provided to help patients develop coping strategies. Psychological interventions such as cognitive behavioral therapy may help reduce internalized stigma and enhance their sense of self-identity [37]. Within healthcare settings, it is important to establish a non-discriminatory care environment by regulating the attitudes and behaviors of healthcare providers. In addition, providing private consultation spaces may help alleviate patients' concerns about identity disclosure and enhance their sense of security and trust in healthcare services [38]. At the societal level, anti-discrimination education should be strengthened to improve public understanding of HIV infection and the MSM population, thereby creating an inclusive and supportive social environment [38]. Psychological resilience Psychological resilience was a protective factor for patient activation among MSM living with HIV ( β =0.272, P <0.001). Higher levels of psychological resilience were related to higher levels of patient activation, consistent with the findings by Yin et al. [39]. In this study, the level of psychological resilience among MSM living with HIV was moderate. This may be due to lifelong medication, drug side effects, and disease progression, which impose physical and psychological stress. In addition, frequent exposure to social discrimination may trigger negative emotions such as anxiety and depression, thereby depleting psychological resources [40]. Psychological resilience refers to a state and capacity in which individuals maintain better-than-expected psychological functioning after experiencing adversity that may exceed their personal resources [41]. MSM living with HIV who have higher psychological resilience tend to exhibit stronger adaptive abilities when facing disease-related challenges and stress, enabling them to overcome barriers in HIV treatment and management and maintain higher levels of patient activation [39]. Patients with higher psychological resilience are more likely to regulate their emotions and reduce the impact of negative emotions [42], thereby alleviating psychological stress. This enables them to engage more actively in health-promoting behaviors and communicate with healthcare providers to acquire disease-related knowledge and skills. Therefore, healthcare providers should place greater emphasis on the systematic assessment of psychological status among MSM living with HIV. Interventions such as peer support, family-based interventions, and cognitive behavioral therapy may help enhance psychological resilience [40,43], equipping patients with greater psychological resources to cope with disease-related challenges, thereby improving patient activation. Social support Social support is an important protective factor for patient activation among MSM living with HIV ( β =0.362, P <0.001). Greater social support was associated with higher levels of patient activation, which is consistent with the findings of Chapman Lambert et al. [22]. In this study, MSM living with HIV reported a moderate level of social support. This may stem from disease-related stress and social stigma associated with HIV infection, as well as identity-related challenges arising from sexual minority status [44, 45]. Social support refers to the emotional and material support that individuals receive from their social networks [21]. Such support helps reduce negative emotions such as loneliness and stigma and enables individuals to better cope with psychological stress [46]. In addition, social support can enhance individuals' sense of value and reduce feelings of helplessness during health management, encouraging them to utilize external resources to cope with disease-related challenges and participate more actively in health management [47, 48]. These findings suggest that healthcare providers should pay attention to assessing and improving the level of social support among MSM living with HIV. Interventions such as peer support groups can be established to promote emotional communication and mutual assistance among patients, thereby enhancing their confidence in coping with the disease [49]. Cognitive behavioral therapy may help correct negative social cognitions and encourage patients to seek social support [50]. Mobile health platforms can also be used to deliver digital interventions, such as information dissemination and anonymous counseling, to promote patients' engagement with social support resources [51]. Strengths and limitations This study has several strengths. First, it focused on MSM living with HIV, a key population in HIV prevention and management. While most studies on patient activation in China have focused on individuals with chronic diseases such as diabetes and cancer, evidence regarding MSM living with HIV remains limited. Therefore, this study provides additional evidence by systematically examining the level of patient activation and its associated factors in this population. Second, this study comprehensively examined psychosocial factors, including perceived discrimination, psychological resilience, and social support, and identified key factors associated with patient activation through multiple linear regression analysis. These findings may help clinicians identify individuals at risk of low patient activation and provide evidence for developing targeted interventions to improve health management in this population. Several limitations should also be acknowledged. First, the cross-sectional design limits the ability to infer causal relationships between patient activation and the associated factors. Second, participants were recruited from a single hospital using convenience sampling, which may introduce selection bias and limit the generalizability of the findings to other regions or populations. Third, the data were collected using self-reported questionnaires, which may be subject to reporting bias and social desirability bias. Future longitudinal and multi-center studies are needed to further validate and extend these findings. Conclusion This study found that patient activation among MSM living with HIV in China was at a moderate level. Shorter duration since diagnosis, a higher number of comorbidities, non-disclosure of HIV status, higher perceived discrimination, lower psychological resilience, and insufficient social support were associated with lower patient activation. These findings suggest that clinical and public health interventions should target these factors, using comprehensive strategies such as psychosocial support, resilience enhancement, and strengthening social support, to improve patient activation and promote effective self-management among this population. Abbreviations AIDS Acquired immunodeficiency syndrome HIV Human immunodeficiency virus MSM Men who have sex with men ART Antiretroviral therapy Declarations Ethics approval and consent to participate Ethics approval was obtained from the Ethics Committee of Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Approval No. 2025-LS-ky120). All participants signed the informed consent. Consent for publication Not applicable. Data availability Data are available from the corresponding author on reasonable request. Competing interests All authors declare no competing interests. Funding This research was sponsored by the Talent Support Project of Nanjing Second Hospital in 2023 (RCMS23014). Authors' contributions RH and MYW contributed to the study design, participant recruitment, data collection and analysis, and manuscript drafting. YHW and WWY made contributions to data consolidation and analysis. RH completed the revision of the manuscript. YS supervised the study and provided guidance on the writing and revision of the manuscript. The submitted version was approved by all authors. Acknowledgements Sincerely thanks to all participants and group members that devoted their time on this study. References UNAIDS.Global HIV&AIDS statistics—Fact sheet[EB/OL]. (2025-07-11)[2026-3-5]. https://www.unaids.org/en/resources/fact-sheet. National AIDS and STD epidemic situation in China, December 2024. 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Health Qual Life Outcomes. 2017 May 30;15(1):115.DOI: 10.1186/s12955-017-0691-z. Shao Y, Xu Y, Yuan X, et al. Investigation on health-related quality of life and influencing factors among HIV-infected individuals receiving antiviral therapy. Chin J AIDS STD. 2025,31(02):184-189. DOI:10.13419/j.cnki.aids.2025.02.12. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. doi: 10.1002/da.10113. Yu X, Zhang J. A Comparison between the Chinese Version of Ego-Resiliency Scale and Connor-Davidson Resilience Scale. Psychol Sci. 2007,(05):1169-1171. DOI:10.16719/j.cnki.1671-6981.2007.05.035. Xiao S. Theoretical basis and research application of the Social Support Rating Scale. J Clin Psychiatry. 1994,(02):98-100. Chapman Lambert C, Fazeli PL, Yigit I, et al. The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study. J Assoc Nurses AIDS Care. 2022 Jan-Feb 01;33(1):78-88.DOI: 10.1097/JNC.0000000000000312. Han S, Zhang Y, Yang X, et al. The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis. BMJ Glob Health. 2023 Feb;8(2):e010966.DOI: 10.1136/bmjgh-2022-010966. Barnes EL, Long MD, Kappelman MD, et al. High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019 Jun 18;25(7):1248-1254.DOI: 10.1093/ibd/izy378. Kim J, Lee E, Park BJ, et al. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009-2016: A nationwide study. Sci Rep. 2018 Feb 16;8(1):3133.DOI: 10.1038/s41598-018-21081-x. Qin Z, Cao G, Xie J, et al. Disease acceptance in HIV/AIDS patients and related factors. Chin J Infect Control. 2024,23(08):1016-1022. Tusa N, Kautiainen H, Elfving P, et al. Relationship between patient activation measurement and self-rated health in patients with chronic diseases. BMC Fam Pract. 2020 Nov 4;21(1):225.DOI: 10.1186/s12875-020-01301-y. Chen J, Liu W, Chen J, et al. Research progress on the status quo and relevant influencing factors of treatment burden among patients with multimorbidity. Gen Pract Nurs. 2024,22(19):3588-3592. You X, Gu J, Wen Q, et al. Social alienation status and influencing factors among HIV-positive young and middle-aged MSM. Chin J AIDS STD. 2024,30(07):704-709. DOI:10.13419/j.cnki.aids.2024.07.07. Jia W, Jiao K, Ma J, et al. HIV infection disclosure, treatment self-efficacy and quality of life in HIV-infected MSM receiving antiretroviral therapy. BMC Infect Dis. 2022 Dec 13;22(1):937.DOI: 10.1186/s12879-022-07932-z. Feng L, Wang Y, Zhang X, et al. Qualitative researches on the real experiences of self-disclosure among HIV infected men who have sex with men in China: a meta-synthesis. Chin J AIDS STD. 2026,32(02):231-236. DOI:10.13419/j.cnki.aids.2026.02.18. Ma J, Jiao K, Liao M, et al. HIV Status Disclosure and Associated Characteristics Among HIV-Positive MSM Receiving Antiretroviral Therapy in Jinan, China. AIDS Behav. 2023 Jul;27(7):2205-2215. doi: 10.1007/s10461-022-03952-7. Wei D, Wang X, You X, et al. Prevalence of depression, anxiety and suicide among men who have sex with men in China: a systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2020 Jun 15;29:e136.DOI: 10.1017/S2045796020000487. Fu J, Chen X, Dai Z, et al. HIV-related stigma, depression and suicidal ideation among HIV-positive MSM in China: a moderated mediation model. BMC Public Health. 2023 Oct 27;23(1):2117. doi: 10.1186/s12889-023-17047-y. Mi T, Lan G, Yang X, et al. HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis. Am J Mens Health. 2022 Mar-Apr;16(2):15579883221087531.DOI: 10.1177/15579883221087531. Tao Y, Xiao X, Xie J, et al. Research progress on current status and influencing factors of disease self-management in AIDS patients. J Nurses Train. 2022,37(11):978-983. DOI:10.16821/j.cnki.hsjx.2022.11.005. Gunn JKL, Rooks-Peck C, Wichser ME, et al. Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses. AIDS Behav. 2022 Jan;26(Suppl 1):51-89. doi: 10.1007/s10461-021-03358-x. Hao J, Chen J, Feng L. Research progress on the stigmatization of elder patients living with HIV in healthcare settings. Chin J AIDS STD. 2025,31(07):805-809. DOI:10.13419/j.cnki.aids.2025.07.20. Yin Y, Lv D, Ren Y, et al. Correlation between patient activation and psychological resilience among hospitalized patients with type 2 diabetes. Chin J Prev Control Chronic Dis. 2021,29(03):206-210. DOI:10.16386/j.cjpccd.issn.1004-6194.2021.03.011. Liu X, Luo L, Ye Z, et al. Research progress on psychological resilience of human immunodeficiency virus/acquired immunodeficiency syndrome patients. China J Sex Sci. 2025,34(04):131-135. Troy AS, Willroth EC, Shallcross AJ, et al. Psychological Resilience: An Affect-Regulation Framework. Annu Rev Psychol. 2023 Jan 18;74:547-576. doi: 10.1146/annurev-psych-020122-041854. Imran A, Tariq S, Kapczinski F, et al. Psychological resilience and mood disorders: a systematic review and meta-analysis. Trends Psychiatry Psychother. 2024;46:e20220524. doi: 10.47626/2237-6089-2022-0524. Chepkemoi S, Nyikavaranda P, Semrau M, et al. Resilience resources for mental health among people living with HIV: a mixed-method systematic review. AIDS Care. 2024 Jul;36(7):849-863. doi: 10.1080/09540121.2024.2303613. Zhang X, Wang X, Wang H, et al. Stigmatization and Social Support of Pregnant Women With HIV or Syphilis in Eastern China: A Mixed-Method Study. Front Public Health. 2022 Mar 11;10:764203. doi: 10.3389/fpubh.2022.764203. Yang H, Yuan Q, Wang Y, et al. Social support and mental health among MSM living with HIV in Sichuan Province. J Sichuan Univ Med Sci Ed. 2018,49(06):966-969. DOI:10.13464/j.scuxbyxb.2018.06.029. He Y, Wang Y, Xie J, et al. Mediating effect of psychological capital on perceived social support and patient activation among stroke patients in the recovery stage. J Nurs. 2023,30(07):65-70. DOI:10.16460/j.issn1008-9969.2023.07.065. Matthias MS, Hirsh AT, Ofner S, et al. Exploring the Relationships Among Social Support, Patient Activation, and Pain-Related Outcomes. Pain Med. 2022 Apr 8;23(4):676-685. doi: 10.1093/pm/pnab306. Li M, Li H, Zhang J, et al. Determinants of patient activation in young and middle-aged breast cancer survivors after surgery. J Nurs Sci. 2024,39(01):52-55. Øgård-Repål, Anita,Berg,et al. Peer support in an outpatient clinic for people living with human immunodeficiency virus: a qualitative study of service users' experiences.[J]. BMC Health Services Research,2022,Vol.22(1): 1-13.DOI:10.1186/s12913-022-07958-8 Zhang Y, Xu Y, Wang H, et al. Impact of cognitive-behavioral intervention on the stigma and family support of HIV/AIDS patients. 2021,35(16):2869-2873. Cooper H, Reif S, Shilling S, et al. Social media support group: Implementation and evaluation. AIDS Care. 2021 Apr;33(4):502-506. doi: 10.1080/09540121.2020.1748171. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9081397","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607236960,"identity":"f0df54de-5375-4a07-a45c-8a3d18413146","order_by":0,"name":"Rui Huang","email":"","orcid":"","institution":"Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Huang","suffix":""},{"id":607236961,"identity":"2e9516b9-2b7e-4b2f-ac75-bb0ef533d753","order_by":1,"name":"Mengya Wang","email":"","orcid":"","institution":"Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mengya","middleName":"","lastName":"Wang","suffix":""},{"id":607236962,"identity":"b8965ba1-c8c1-481e-b8db-9cea9ebd4149","order_by":2,"name":"Yuhan Wu","email":"","orcid":"","institution":"Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuhan","middleName":"","lastName":"Wu","suffix":""},{"id":607236963,"identity":"5a08db1d-7bf5-4509-b5aa-3f82f353b6ad","order_by":3,"name":"Wenwen Yang","email":"","orcid":"","institution":"Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wenwen","middleName":"","lastName":"Yang","suffix":""},{"id":607236964,"identity":"a740bc46-a744-4cb1-b5ef-73aef851f405","order_by":4,"name":"Yan Song","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFCCAwwMCT/+y4EZQMDYQJSWjz3MxqRoAaqawcacCFNJWIs54xkzaR4etvTtjGcMP91gsJHdcID52QN8WiwbQFoseHJ3Npwxls5hSDPecIDN3ACfFoMDYFskcjcAGcw5DIcTNxzgYZMgrIXNIN0AouU/cVokZ7AlJEC1HCBGy7Fii489Bww3ABnSOQbJxjMPs5nh13Lj8MYbCT8OyIMYn3Mq7GT7jjc/w6uFQeKECUSBxAGQCUDMjFc9EPC3P/4AYTQQUjoKRsEoGAUjFQAAgx9QdELS3gEAAAAASUVORK5CYII=","orcid":"","institution":"The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Song","suffix":""}],"badges":[],"createdAt":"2026-03-10 08:40:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9081397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9081397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105034125,"identity":"83451e28-679c-4135-9471-4c771343b4ee","added_by":"auto","created_at":"2026-03-20 07:22:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1516497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9081397/v1/862c961c-88cd-4288-8e81-d8004ff8a473.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychosocial Factors Associated with Patient Activation among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcquired immunodeficiency syndrome (AIDS) is a chronic infectious disease caused by the human immunodeficiency virus (HIV) and remains a major global public health challenge. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), approximately 40.8\u0026nbsp;million people worldwide were living with HIV/AIDS by the end of 2024 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, about 1.35\u0026nbsp;million people were living with HIV/AIDS by the end of 2024, with 102,000 newly reported cases in that year. Sexual transmission is the predominant route of infection, with male-to-male sexual transmission accounting for more than one quarter of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Men who have sex with men (MSM) are a key population at high risk for HIV infection in China, with a substantially higher infection risk than the general population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCompared with other people living with HIV, MSM living with HIV present several unique characteristics. First, this population often faces intersectional stigma related to both HIV status and sexual minority identity, which may lead to discrimination and social exclusion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Studies have shown that the prevalence of depression among MSM living with HIV is significantly higher than that in the general population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Second, fear of HIV status disclosure is common among MSM. Concerns about discrimination may lead some individuals to conceal their status or delay seeking medical care, which may negatively affect disease management [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, focusing on MSM living with HIV and exploring their health management issues in depth is of great importance for improving health outcomes and contributing to HIV prevention efforts.\u003c/p\u003e \u003cp\u003eWith the widespread use of antiretroviral therapy (ART), the life expectancy of people living with HIV has significantly increased [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. HIV infection has gradually been transformed into a chronic condition requiring long-term management [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this context, the role of patients in disease management has become increasingly important. They are required to maintain long-term medication adherence, monitor disease progression, manage symptoms, and sustain healthy lifestyle behaviors.\u003c/p\u003e \u003cp\u003ePatient activation refers to the knowledge, skills, confidence, and beliefs that individuals possess in managing their own health [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and it is considered an important factor in promoting effective self-management [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies have shown that patient activation plays a significant role in improving health outcomes among individuals with chronic diseases and is an important predictor of health behaviors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For MSM living with HIV, maintaining and enhancing patient activation is particularly important due to lifelong ART, medication side effects, and psychosocial pressures.\u003c/p\u003e \u003cp\u003eAlthough patient activation has received increasing attention in recent years, most studies in China have focused on populations with chronic non-communicable diseases such as diabetes and cancer. However, little is known about how psychosocial factors such as perceived discrimination, psychological resilience, and social support are associated with patient activation among MSM living with HIV in China. From a psychosocial perspective, these factors are hypothesized to play a critical role in shaping individuals' motivation, confidence, and ability to engage in health self-management. Therefore, this study conducted a cross-sectional survey to examine patient activation among MSM living with HIV. The study analyzed the influence of demographic and disease-related characteristics and explored the associations between perceived discrimination, psychological resilience, social support, and patient activation. The aim of this study was to identify factors associated with patient activation among MSM living with HIV and to inform targeted psychosocial interventions to enhance patient activation in clinical practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted among MSM living with HIV who attended the Department of Infectious Diseases at Nanjing Second Hospital, a designated hospital for HIV/AIDS treatment in Nanjing, China. Participants were recruited between December 2025 and February 2026.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection of Participants and sample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were recruited using a convenience sampling method and included MSM living with HIV who met the inclusion and exclusion criteria. The inclusion criteria were: (1) aged \u0026ge;18 years; (2) previously diagnosed with HIV; (3) self-reported HIV transmission through male-to-male sexual behavior; (4) provided informed consent and voluntarily agreed to participate in the study. The exclusion criteria were: (1) severe cognitive impairment or psychiatric disorders; (2) presence of severe somatic diseases.\u003c/p\u003e\n\u003cp\u003eA total of 24 variables were considered in this study. The required sample size was estimated to be 5\u0026ndash;10 times the number of variables [14]. Assuming a 20% invalid response rate, a minimum sample size of 150\u0026ndash;300 participants was required. A total of 311 questionnaires were distributed, and 303 valid responses were obtained, yielding a response rate of 97.43%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was self-developed by the researchers based on a literature review and included items on age, residence, marital status, educational level, employment status, monthly income, Medical expense payment way, duration since HIV diagnosis, number of comorbidities, and disclosure of HIV status to others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Activation Measure-13 (PAM-13)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PAM-13 was developed and revised by Judith H. Hibbard et al. [15]. It consists of 13 items covering four dimensions: cognition, skill, action, and belief. Each item is rated on a 4-point Likert scale ranging from \u0026quot;strongly disagree\u0026quot; to \u0026quot;strongly agree,\u0026quot; scored from 1 to 4, with \u0026quot;not applicable\u0026quot; scored as 0. The raw score is calculated as the sum of all item scores and is subsequently converted into a standardized patient activation score on a 0\u0026ndash;100 scale using the scoring conversion algorithm authorized by Insignia Health. Based on the standardized score, patient activation is categorized into four levels: level 1 (\u0026le;47.0), level 2 (47.1\u0026ndash;55.1), level 3 (55.2\u0026ndash;67.0), and level 4 (\u0026ge;67.1), with higher scores indicating higher levels of patient activation [16]. In this study, the Cronbach\u0026apos;s \u0026alpha; coefficient of the scale was 0.847, and the KMO value was 0.783, indicating good reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBerger HIV stigma scale-12 (BHSS-12)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BHSS-12 was revised by Marcus E. Reinius et al. [17]. It consists of 12 items across four dimensions: personalised stigma, disclosure concerns, concerns about public attitudes, and negative self-image. Each item is rated on a 4-point Likert scale ranging from \u0026quot;strongly disagree\u0026quot; to \u0026quot;strongly agree,\u0026quot; scored from 1 to 4. The total score is calculated as the sum of all item scores, ranging from 12 to 48. Based on previous literature [18], participants were categorized into three levels of perceived discrimination\u0026mdash;none or mild, moderate, and severe\u0026mdash;according to the 33rd and 66th percentiles of the scale scores in the study population. In this study, the Cronbach\u0026apos;s \u0026alpha; coefficient of the scale was 0.861, and the KMO value was 0.832, indicating good reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConnor-Davidson Resilience Scale (CD-RISC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CD-RISC was developed by Connor and Davidson [19] and later revised for the Chinese population by Xiao N et al. [20]. The scale consists of 25 items across three dimensions: optimism, strength, and tenacity. Each item is rated on a 5-point Likert scale ranging from \u0026quot;not true at all\u0026quot; to \u0026quot;true nearly all the time,\u0026quot; scored from 0 to 4. The total score is calculated as the sum of all items, ranging from 0 to 100, with higher scores indicating greater psychological resilience. In this study, the Cronbach\u0026apos;s \u0026alpha; coefficient of the scale was 0.897, and the KMO value was 0.912, indicating good reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Support Rating Scale (SSRS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SSRS was developed by Xiao S [21] to assess the level of social support. The scale consists of 10 items across three dimensions: subjective support, objective support, and utilization of social support, with a total possible score of 66. The total score is calculated as the sum of all item scores, with higher scores indicating better social support. According to the total score, social support is categorized into three levels: low (22), moderate (22\u0026ndash;44), and high (45\u0026ndash;66). In this study, the Cronbach\u0026apos;s \u0026alpha; coefficient of the scale was 0.802, and the KMO value was 0.844, indicating good reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected by two nursing postgraduate students who received standardized training prior to the study. Participants were informed of the study purpose, questionnaire requirements, and confidentiality principles using standardized instructions. After providing informed consent, participants completed paper questionnaires on site. Questionnaires were collected immediately and checked for completeness, with any missing items promptly supplemented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 26.0. Categorical variables were presented as frequencies (n) and percentages (%), and continuous variables with a normal distribution were presented as mean \u0026plusmn; standard deviation (SD). Independent-samples t-tests and one-way analysis of variance (ANOVA) were used to compare differences between groups. Pearson correlation analysis was performed to examine associations between variables, and multiple linear regression analysis was used to identify factors influencing patient activation. A two-tailed \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eSince data were collected via self-reported questionnaires, common method bias (CMB)\u0026nbsp;could\u0026nbsp;affect the study validity. Therefore, Harman\u0026apos;s single-factor test was conducted. The results showed that 15 factors had eigenvalues greater than 1, and the first factor accounted for 22.79% of the total variance, which is below the critical threshold of 40%.\u0026nbsp;Therefore, there was no serious common method bias in the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe ethical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Approval No. 2025-LS-ky120). Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of the 303 participants was 37.96 \u0026plusmn; 10.46 years. Among them, 216 (71.29%) were unmarried, 62 (20.46%) were married, 24 (7.92%) were divorced, and 1 (0.33%) was widowed. Detailed information is presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e \u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCharacteristics of participants (n=303)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e18-＜30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e21.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e30-＜40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e42.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e40-＜50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e20.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e15.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e70.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e29.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e71.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e20.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e7.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003ePrimary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e14.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eSenior high school or technical secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e16.50\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e32.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e36.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e87.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u0026nbsp;\u003c/strong\u003e(CNY)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e＜1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e1000-＜3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e7.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e3000-＜5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ge;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e83.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical expense payment way\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eMedical insurance for urban employees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e69.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eMedical insurance for urban and rural residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e8.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eSelf-paid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration since HIV diagnosis (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e＜1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e7.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e1-＜5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e27.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e5-＜9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e28.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ge;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e36.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e56.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e28.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e9.90\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 568px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure of HIV status to others\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e72.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e27.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eScores of patient activation, perceived discrimination, psychological resilience, and social support among MSM living with HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient activation score among MSM living with HIV was 55.68 \u0026plusmn; 9.62. The scores for perceived discrimination, psychological resilience, and social support were 33.19 \u0026plusmn; 4.56, 63.26 \u0026plusmn; 10.20, and 34.32 \u0026plusmn; 7.64, respectively. The scores of each dimension of patient activation are presented in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Scores of each dimension of patient activation among MSM living with HIV (n=303)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eDimensions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eItems (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003eScore (\u003cimg width=\"6\" height=\"16\" src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1773856998.gif\" alt=\"image\"\u003e\u0026plusmn;\u0026nbsp;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eMean item score (\u003cimg width=\"6\" height=\"16\" src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1773856998.gif\" alt=\"image\"\u003e\u0026plusmn;\u0026nbsp;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eBelief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e5.27\u0026plusmn;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e2.63\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eCognition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e6.91\u0026plusmn;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e3.46\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eBehavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e8.55\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e2.85\u0026plusmn;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eSkill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e17.29\u0026plusmn;2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e2.88\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis of patient activation among MSM living with HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the univariate analysis showed that patient activation levels differed significantly among MSM living with HIV with different durations since HIV diagnosis, numbers of comorbidities, and disclosure of HIV status to others (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). The results are shown in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Comparison of patient activation scores among MSM living with HIV (n=303)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epatient activation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(\u003cimg width=\"8\" height=\"16\" src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1773856998.gif\" alt=\"image\"\u003e\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/strong\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e18-＜30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.13\u0026plusmn;10.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e30-＜40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.08\u0026plusmn;9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e40-＜50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55.65\u0026plusmn;10.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53.98\u0026plusmn;8.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.10\u0026plusmn;10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e54.68\u0026plusmn;8.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMartial status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e2.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.30\u0026plusmn;9.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53.37\u0026plusmn;9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.77\u0026plusmn;7.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e40.70\u0026plusmn;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003ePrimary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e52.55\u0026plusmn;7.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e54.69\u0026plusmn;8.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eSenior high school or technical secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53.71\u0026plusmn;9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55.26\u0026plusmn;9.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e57.39\u0026plusmn;10.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.810\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55.63\u0026plusmn;9.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.57\u0026plusmn;8.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e57.30\u0026plusmn;8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53.49\u0026plusmn;11.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e \u003cstrong\u003e(CNY)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e＜1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e52.43\u0026plusmn;3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e1000-＜3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e52.56\u0026plusmn;9.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e3000-＜5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e54.41\u0026plusmn;10.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e\u0026ge;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.17\u0026plusmn;9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical expense payment way\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eMedical insurance for urban employees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.33\u0026plusmn;9.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eMedical insurance for urban and rural residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55.08\u0026plusmn;9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eSelf-paid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53.93\u0026plusmn;10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e52.20\u0026plusmn;25.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration since HIV diagnosis (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e5.072\u003cem\u003ea\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e＜1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e48.46\u0026plusmn;9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e1-＜5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.68\u0026plusmn;11.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e5-＜9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55.28\u0026plusmn;9.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e\u0026ge;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.75\u0026plusmn;7.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.70\u0026plusmn;9.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56.10\u0026plusmn;9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e51.21\u0026plusmn;8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e50.15\u0026plusmn;12.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure of HIV status to others\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e57.23\u0026plusmn;9.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e51.66\u0026plusmn;9.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u003cem\u003ea\u003c/em\u003e indicates the \u003cem\u003eF\u003c/em\u003e-value obtained from the Welch test when the assumption of homogeneity of variance was not met.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation analysis of patient activation with perceived discrimination, psychological resilience, and social support among MSM living with HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis showed that patient activation was negatively correlated with perceived discrimination (\u003cem\u003er\u003c/em\u003e = \u0026minus;0.553, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01) and positively correlated with psychological resilience (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= 0.495, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01) and social support (\u003cem\u003er\u003c/em\u003e = 0.544, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01) among MSM living with HIV. The results are shown in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Correlation analysis among variables (r-value, n = 303)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003epatient activation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003ePerceived discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003epsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003epatient activation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003ePerceived discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e-0.553**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003epsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.495**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.424**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.544**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.326**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.246**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: **\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate analysis of patient activation among MSM living with HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient activation total score was set as the dependent variable, and variables that were significant in the univariate analysis, along with perceived discrimination, psychological resilience, and social support, were included as independent variables in a multiple linear regression analysis. The variance inflation factors (VIF) ranged from 1.004 to 1.401 (\u0026lt;5), and tolerance values (TOL) were all \u0026gt;0.1, indicating no multicollinearity. The coding of independent variables is shown in Table 5. The results indicated that duration since HIV diagnosis, number of comorbidities, disclosure of HIV status to others, perceived discrimination, psychological resilience, and social support were all significant predictors of patient activation (all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), explaining 55.3% of the total variance (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Coding of independent variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;Independent variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eCoding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eDuration since HIV diagnosis (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e＜1=1, 1-＜5=2, 5-＜9=3, \u0026ge;9=4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eNumber of comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003e0=1, 1=2, 2=3, \u0026ge;3=4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eDisclosure of HIV status to others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eYes=1, No=2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003ePerceived discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eOriginal score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eOriginal score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 292px;\"\u003e\n \u003cp\u003eOriginal score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Multiple linear regression analysis of patient activation (n = 303)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eTOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003eDuration since HIV diagnosis (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e2.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003eNumber of comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-2.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-4.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003eDisclosure of HIV status to others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-2.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-2.330\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.020\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003ePerceived discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-0.600\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-6.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 220px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e8.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1.152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u003cem\u003eR\u0026sup2;\u0026nbsp;\u003c/em\u003e=0.562, Adjusted \u003cem\u003eR\u0026sup2;\u0026nbsp;\u003c/em\u003e=0.553, \u003cem\u003eF\u0026nbsp;\u003c/em\u003e=63.278, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003ePatient activation among MSM living with HIV was at a moderately high level\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that the level of patient activation among MSM living with HIV was moderately high. According to the grading criteria of the PAM, the total score corresponded to level 3 [16]. At this level, patients are prepared to take self-management actions but still lack sufficient skills and confidence to sustain these behaviors. This result was lower than that reported by Chapman Lambert et al. among young Black women living with HIV [22]. This discrepancy may be attributed to differences in study populations, sociocultural contexts, and psychosocial resources.\u003c/p\u003e\n\u003cp\u003eThe mean scores in the belief dimension were relatively low, suggesting that some MSM living with HIV lacked confidence in coping with disease-related challenges and maintaining healthy behaviors. This may be associated with HIV-related stigma, societal prejudice toward sexual minorities, the psychological burden of chronic disease, and insufficient social acceptance. The mean scores in the behavior dimension were at a moderate level, suggesting that some patients may face difficulties translating health knowledge into practice.\u003c/p\u003e\n\u003cp\u003eTherefore, healthcare providers should place greater emphasis on assessing patient activation among MSM living with HIV. Targeted interventions, such as psychological and peer support, may help strengthen patients\u0026apos; confidence in coping with the disease and enhance their engagement in self-management [23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluencing factors of patient activation among MSM living with HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration since HIV diagnosis \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings suggest that duration since HIV diagnosis was an important factor associated with patient activation (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.091, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Patients with a shorter duration since HIV diagnosis exhibited lower levels of patient activation, which is consistent with the findings reported by Barnes et al. [24]. This may be because MSM in the early stage after HIV diagnosis may not yet have fully accepted their infection status and often experience negative emotional reactions, such as denial, anger, and depression [25]. In addition, the psychological burden associated with HIV-related stigma may lead some patients to conceal their infection status or avoid seeking necessary medical support [7]. Moreover, patients at this stage may have limited awareness of HIV and the importance of ART. In the absence of an established follow-up system or clear feedback regarding treatment outcomes, they may find it difficult to perceive the benefits of treatment, which may ultimately reduce their motivation for self-management [25].\u003c/p\u003e\n\u003cp\u003eThese findings suggest that healthcare providers should pay particular attention to MSM in the early stage after HIV diagnosis. Timely psychological counseling and individualized health education should be provided to help patients develop an accurate understanding of HIV and accept their health status, thereby improving patient activation and treatment adherence [26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of comorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed that patients with a higher number of comorbidities tended to have lower levels of patient activation (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.192, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). This may be because multiple comorbidities increase the burden of health management. With an increasing number of comorbidities and longer disease duration, patients may experience repeated challenges in long-term disease management, potentially leading to frustration and ultimately reducing their motivation for self-management [27].\u003c/p\u003e\n\u003cp\u003eTherefore, in clinical practice, healthcare providers should pay particular attention to MSM living with HIV with a higher number of comorbidities and offer comprehensive disease management support. Integrating healthcare resources and establishing multidisciplinary teams to provide one-stop healthcare services may help reduce patients\u0026apos; healthcare burden and enhance their engagement in self-management [28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of HIV status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that disclosure of HIV status to others was a protective factor for patient activation among MSM living with HIV (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.095, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Those who disclosed their HIV status demonstrated higher levels of patient activation compared with those who did not.\u003c/p\u003e\n\u003cp\u003eDisclosing HIV status to trusted partners, family members, or friends may enable MSM living with HIV to obtain emotional and practical support, which can help alleviate social isolation and facilitate acceptance of their health status [29]. Furthermore, such support may mitigate the psychological burden associated with the dual stigma of HIV and sexual minority status, reduce the need to hide their HIV status, and ultimately enhance patients\u0026apos; confidence and motivation to engage in health management behaviors [30, 31].\u003c/p\u003e\n\u003cp\u003eDisclosure of HIV status is influenced by multiple factors. In clinical practice, healthcare providers should fully respect patients\u0026apos; autonomy in disclosure decisions. Disclosure counseling should be provided at key time points, such as shortly after diagnosis and during follow-up visits, to help patients identify appropriate disclosure targets and develop effective communication strategies, thereby enhancing the positive effects of disclosure while minimizing potential negative consequences [32]. In addition, healthcare providers should also recognize differences in patients\u0026apos; motivations for disclosure, provide targeted support to address the psychological and social challenges they may face, and help patients develop individualized disclosure strategies [31].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived discrimination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerceived discrimination was an important influencing factor of patient activation among MSM living with HIV (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.284, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Higher levels of perceived discrimination were associated with lower levels of patient activation, which is consistent with previous studies [33].\u003c/p\u003e\n\u003cp\u003eIn this study, MSM living with HIV reported a moderate level of perceived discrimination, suggesting that perceived discrimination remains prevalent in this population. This may stem from the overlapping stigma associated with both sexual minority identity and HIV infection [33]. Traditional Chinese cultural values emphasizing heterosexual marriage and continuation of the family lineage may further intensify the prejudice they face within families and society [34-35].\u003c/p\u003e\n\u003cp\u003eTo avoid social rejection, MSM living with HIV may conceal their HIV status and avoid necessary healthcare services, which may contribute to lower levels of patient activation [7]. Persistent negative social feedback may gradually influence patients\u0026apos; self-perception, resulting in psychological distress and self-stigma. These psychological responses may foster a negative self-image and feelings of low self-worth, thereby weakening their motivation to maintain healthy behaviors [36].\u003c/p\u003e\n\u003cp\u003eGiven the negative impact of perceived discrimination on patient activation among MSM living with HIV, multilevel interventions are needed to mitigate its adverse effects. At the individual level, discrimination-related training can be provided to help patients develop coping strategies. Psychological interventions such as cognitive behavioral therapy may help reduce internalized stigma and enhance their sense of self-identity [37]. Within healthcare settings, it is important to establish a non-discriminatory care environment by regulating the attitudes and behaviors of healthcare providers. In addition, providing private consultation spaces may help alleviate patients\u0026apos; concerns about identity disclosure and enhance their sense of security and trust in healthcare services [38]. At the societal level, anti-discrimination education should be strengthened to improve public understanding of HIV infection and the MSM population, thereby creating an inclusive and supportive social environment [38].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological resilience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological resilience was a protective factor for patient activation among MSM living with HIV (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.272, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Higher levels of psychological resilience were related to higher levels of patient activation, consistent with the findings by Yin et al. [39].\u003c/p\u003e\n\u003cp\u003eIn this study, the level of psychological resilience among MSM living with HIV was moderate. This may be due to lifelong medication, drug side effects, and disease progression, which impose physical and psychological stress. In addition, frequent exposure to social discrimination may trigger negative emotions such as anxiety and depression, thereby depleting psychological resources [40].\u003c/p\u003e\n\u003cp\u003ePsychological resilience refers to a state and capacity in which individuals maintain better-than-expected psychological functioning after experiencing adversity that may exceed their personal resources [41]. MSM living with HIV who have higher psychological resilience tend to exhibit stronger adaptive abilities when facing disease-related challenges and stress, enabling them to overcome barriers in HIV treatment and management and maintain higher levels of patient activation [39]. Patients with higher psychological resilience are more likely to regulate their emotions and reduce the impact of negative emotions [42], thereby alleviating psychological stress. This enables them to engage more actively in health-promoting behaviors and communicate with healthcare providers to acquire disease-related knowledge and skills.\u003c/p\u003e\n\u003cp\u003eTherefore, healthcare providers should place greater emphasis on the systematic assessment of psychological status among MSM living with HIV. Interventions such as peer support, family-based interventions, and cognitive behavioral therapy may help enhance psychological resilience [40,43], equipping patients with greater psychological resources to cope with disease-related challenges, thereby improving patient activation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial support\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocial support is an important protective factor for patient activation among MSM living with HIV (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.362, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Greater social support was associated with higher levels of patient activation, which is consistent with the findings of Chapman Lambert et al. [22].\u003c/p\u003e\n\u003cp\u003eIn this study, MSM living with HIV reported a moderate level of social support. This may stem from disease-related stress and social stigma associated with HIV infection, as well as identity-related challenges arising from sexual minority status [44, 45].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSocial support refers to the emotional and material support that individuals receive from their social networks [21]. Such support helps reduce negative emotions such as loneliness and stigma and enables individuals to better cope with psychological stress [46]. In addition, social support can enhance individuals\u0026apos; sense of value and reduce feelings of helplessness during health management, encouraging them to utilize external resources to cope with disease-related challenges and participate more actively in health management [47, 48].\u003c/p\u003e\n\u003cp\u003eThese findings suggest that healthcare providers should pay attention to assessing and improving the level of social support among MSM living with HIV. Interventions such as peer support groups can be established to promote emotional communication and mutual assistance among patients, thereby enhancing their confidence in coping with the disease [49]. Cognitive behavioral therapy may help correct negative social cognitions and encourage patients to seek social support [50]. Mobile health platforms can also be used to deliver digital interventions, such as information dissemination and anonymous counseling, to promote patients\u0026apos; engagement with social support resources [51].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several strengths. First, it focused on MSM living with HIV, a key population in HIV prevention and management. While most studies on patient activation in China have focused on individuals with chronic diseases such as diabetes and cancer, evidence regarding MSM living with HIV remains limited. Therefore, this study provides additional evidence by systematically examining the level of patient activation and its associated factors in this population. Second, this study comprehensively examined psychosocial factors, including perceived discrimination, psychological resilience, and social support, and identified key factors associated with patient activation through multiple linear regression analysis. These findings may help clinicians identify individuals at risk of low patient activation and provide evidence for developing targeted interventions to improve health management in this population.\u003c/p\u003e\n\u003cp\u003eSeveral limitations should also be acknowledged. First, the cross-sectional design limits the ability to infer causal relationships between patient activation and the associated factors. Second, participants were recruited from a single hospital using convenience sampling, which may introduce selection bias and limit the generalizability of the findings to other regions or populations. Third, the data were collected using self-reported questionnaires, which may be subject to reporting bias and social desirability bias. Future longitudinal and multi-center studies are needed to further validate and extend these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that patient activation among MSM living with HIV in China was at a moderate level. Shorter duration since diagnosis, a higher number of comorbidities, non-disclosure of HIV status, higher perceived discrimination, lower psychological resilience, and insufficient social support were associated with lower patient activation. These findings suggest that clinical and public health interventions should target these factors, using comprehensive strategies such as psychosocial support, resilience enhancement, and strengthening social support, to improve patient activation and promote effective self-management among this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS \u0026nbsp; \u0026nbsp; Acquired immunodeficiency syndrome\u003c/p\u003e\n\u003cp\u003eHIV \u0026nbsp; \u0026nbsp; \u0026nbsp;Human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003eMSM \u0026nbsp; \u0026nbsp; Men who have sex with men\u003c/p\u003e\n\u003cp\u003eART \u0026nbsp; \u0026nbsp; \u0026nbsp;Antiretroviral therapy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Ethics Committee of Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Approval No. 2025-LS-ky120). All participants signed the informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was sponsored by the Talent Support Project of Nanjing Second Hospital in 2023 (RCMS23014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRH and MYW contributed to the study design, participant recruitment, data collection and analysis, and manuscript drafting. YHW and WWY made contributions to data consolidation and analysis. RH completed the revision of the manuscript. YS supervised the study and provided guidance on the writing and revision of the manuscript. The submitted version was approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSincerely thanks to all participants and group members that devoted their time on this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eUNAIDS.Global HIV\u0026amp;AIDS statistics\u0026mdash;Fact sheet[EB/OL]. (2025-07-11)[2026-3-5]. https://www.unaids.org/en/resources/fact-sheet.\u003c/li\u003e\n \u003cli\u003eNational AIDS and STD epidemic situation in China, December 2024. Chin J AIDS STD. 2025,31(03):225. DOI:10.13419/j.cnki.aids.2025.03.01.\u003c/li\u003e\n \u003cli\u003eJing S, Zhong X, Lei X, et al. Marital status and its influence on AIDS-related behaviors among men who have sex with men in Sichuan and Chongqing area. Acad J Second Mil Med Univ. 2016,37(07):910-915. DOI:10.16781/j.0258-879x.2016.07.0910.\u003c/li\u003e\n \u003cli\u003eLiu Y, Qin L, Deng X, et al. High-risk sexual behaviors among MSM: Based on the minority stress model. J Psychiatry. 2020,33(04):316-320.\u003c/li\u003e\n \u003cli\u003eFu H, Feng T, Wang T, et al. Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004-2018: A systematic review and meta-analysis. J Affect Disord. 2020 Dec 1;277:192-203. doi: 10.1016/j.jad.2020.08.011.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi X, Han J, Liu Y, et al. Depression and its related factors of young-middle men who have sex with men with HIV infections. Chin J AIDS STD. 2022,28(04):494-497. DOI:10.13419/j.cnki.aids.2022.04.27.\u003c/li\u003e\n \u003cli\u003eDunn Navarra AM, Whittemore R, Bakken S, et al. Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res. 2020 May/Jun;69(3):197-209. doi: 10.1097/NNR.0000000000000422.\u003c/li\u003e\n \u003cli\u003eTrickey A, Sabin CA, Burkholder G, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023 May;10(5):e295-e307. doi: 10.1016/S2352-3018(23)00028-0.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDeeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013 Nov 2;382(9903):1525-33. doi: 10.1016/S0140-6736(13)61809-7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMa R, Wang J, Zhang R, et al. Concept analysis of patient activation. J Nurs Sci. 2024,39(16):77-82.\u003c/li\u003e\n \u003cli\u003eLightfoot CJ, Nair D, Bennett PN, et al. 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AIDS Care. 2021 Apr;33(4):502-506. doi: 10.1080/09540121.2020.1748171.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"aids-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arty","sideBox":"Learn more about [AIDS Research and Therapy](http://aidsrestherapy.biomedcentral.com/)","snPcode":"12981","submissionUrl":"https://submission.nature.com/new-submission/12981/3","title":"AIDS Research and Therapy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, men who have sex with men, patient activation, perceived discrimination, psychological resilience, social support","lastPublishedDoi":"10.21203/rs.3.rs-9081397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9081397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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, the Berger HIV stigma scale-12, the Connor\u0026ndash;Davidson Resilience Scale, and the Social Support Rating Scale. Pearson correlation analysis, univariate analysis, and multiple linear regression analysis were performed to identify factors associated with patient activation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean patient activation score among MSM living with HIV was 55.68\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62. Pearson correlation analysis showed that patient activation was negatively correlated with perceived discrimination (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.553, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and positively correlated with psychological resilience (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.495, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and social support (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.544, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Multiple linear regression analysis indicated that duration since HIV diagnosis, number of comorbidities, disclosure of HIV status to others, perceived discrimination, psychological resilience, and social support were significant predictors of patient activation (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), explaining 55.3% of the total variance.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatient activation among MSM living with HIV is influenced by multiple psychosocial factors. Interventions aimed at reducing perceived discrimination and enhancing psychological resilience and social support may help improve patient activation and promote effective self-management among MSM living with HIV.\u003c/p\u003e","manuscriptTitle":"Psychosocial Factors Associated with Patient Activation among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 18:06:31","doi":"10.21203/rs.3.rs-9081397/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-18T08:35:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229803348888652555962438511037417395141","date":"2026-04-14T05:05:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T01:17:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T09:02:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T08:27:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"AIDS Research and Therapy","date":"2026-03-10T08:25:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"aids-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arty","sideBox":"Learn more about [AIDS Research and Therapy](http://aidsrestherapy.biomedcentral.com/)","snPcode":"12981","submissionUrl":"https://submission.nature.com/new-submission/12981/3","title":"AIDS Research and Therapy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"acf1b4d9-b829-4cdd-a0b6-7ab60d233cb6","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-18T18:06:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 18:06:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9081397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9081397","identity":"rs-9081397","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}