Complex dynamics between internalized HIV stigma, depression, and anxiety with panic among people with HIV
Lydia N Drumright, Heidi M Crane1, Rob J Fredericksen1
1University of Washington, Seattle.
AIDS (London, England)
|April 21, 2026
Summary
Internalized HIV stigma (IHS) and mental health conditions like depression and anxiety influence each other bidirectionally. This bidirectional relationship impacts viral non-suppression in people with HIV (PWH).
Area of Science:
- Psychiatry
- Infectious Diseases
- Public Health
Background:
- Previous research suggests internalized HIV stigma (IHS) leads to HIV viral non-suppression through increased depression and reduced adherence.
- However, the complex interplay between IHS and mental health requires further investigation.
Purpose of the Study:
- To elucidate the intricate dynamics between internalized HIV stigma (IHS) and mental health (depression, anxiety) in people with HIV (PWH).
- To analyze longitudinal data from a clinical cohort to understand the bidirectional relationships.
Main Methods:
- Utilized multi-state Markov models to analyze data from 8,506 PWH with at least two timepoints of IHS, depression, and anxiety measurements.
- Examined transitions between four-state combinations of depression-IHS and anxiety-IHS states over time.
Main Results:
- Found bidirectional influences between IHS and mental health measures (depression, anxiety), with similar impact rates in both directions.
- Over 50% of PWH remained in consistent IHS-depression or IHS-anxiety states.
- PWH with IHS showed nearly double the rate of transitioning to depression/anxiety compared to those without IHS.
Conclusions:
- Internalized HIV stigma and mental health dynamics are complex and bidirectional, challenging previous linear models.
- These findings necessitate refined analytical approaches and optimized management strategies for PWH experiencing stigma and mental health challenges.
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