The Munich 25th International AIDS Conference
Depression PLH
29 July 2024
By Michael Schulte, UCSD MS3
Examining the relationship between psychological wellbeing, self-efficacy, resilience, and depression among people with HIV. M Schulte et al, UCSD.
This study seeks to examine the relationship between psychological wellbeing, self-efficacy, resilience, and depression among people with HIV. Consistent with prior studies, we found that people with HIV exhibited greater depressive symptom severity compared to people without HIV. However, to our knowledge, this is the first study to report lower psychological wellbeing among PWH using the NIH Toolbox Emotions Battery. Surprisingly, HIV status was not a significant predictor of depressive symptom severity in our multivariable model. Instead, we found that lower psychological wellbeing and lower self-efficacy significantly predicted greater depressive symptom severity among people with and without HIV. This suggests that greater depressive symptom severity in PWH may be due partly to lower psychological wellbeing rather than disease-specific factors alone.
Two other HIV-related mental health studies presented at AIDS 2024 stood out to me.
One out of Florida International University found that inflammation at HIV onset predicts persistent depressive symptoms despite antiretroviral therapy (Chavez et al., 2024). This presents another step forward in characterizing a potential cause and overall profile of depression in people living with HIV. This study provides a biological counterpart to mine which seeks to characterize a potential psychosocial basis for depression in people living with HIV. Clearly, depression in people living with HIV is a complex phenomenon. It is exciting to see researchers of different backgrounds and fields of thought attempting to clarify this complexity with the common goal of improving the mental health of people living with HIV.
Separately, AIDS 2024 was not saved from artificial intelligence. A randomized controlled trial of an AI-based HIV disclosure role-playing conversation simulator out of the University of North Carolina found that the app was an effective intervention to improve decision-making capacity in HIV disclosure among young men who have sex with men living with HIV (Stamp et al., 2024). This represents an important step forward in helping people living with HIV to reduce anxiety and make better decisions related to disclosure—a conversation that remains an act of courage.
Dr Caperna:
Day 5 of conference, the plenary session was on the rapid growth of AI in healthcare including with PLH. Surprisingly, or sadly, AI has been shown to be more compassionate than healthcare workers. It’s faster, cheaper, and we all need chatbot psychotherapy?
The machine is less personal, less intimidating. Maybe more approachable. Self-service gas. Self-checkout. These are inhuman. Antisocial.
Real people need to understand and experience the benefits of compassion.
The idea is to be other-centered. And remember the benefits of human community.
A study from Georgia (the country) showed 50% of women with HIV have depression.
The data, cited by Pablo Radusky from Fundación Huésped from the TransCITAR study, Argentina, involved 480 trans participants and found even higher rates of mental health impact among non-binary individuals. Radusky noted that police violence was found to be a recurring source of stigma and violence experienced by the community. For trans women living with HIV, this situation was found to be exacerbated by a higher probability of experiencing unstable housing, coming from a migrant background and holding less economic power.
Another factor impacting the mental health of trans communities includes a crisis in Chemsex—using illicit substances to enhance sexual experiences—with severe consequences from dating app use including higher rates of depression, suicide, and cardiovascular diseases. Thiago Torres from Fundação Oswaldo Cruz, Brazil highlighted the widespread exclusion of trans and gender diverse individuals from studies on Chemsex but noted that the limited existing research that included disaggregated data from trans communities indicated a higher prevalence among trans women and non-binary people in Latin America. The research found a notable correlation between PrEP (pre-exposure prophylaxis) use and higher instances of chemsex, prompting discussions on harm reduction strategies tailored for trans and gender diverse individuals.