Depression, Anxiety and Stress among People Living with HIV from a Gender and Sexual Orientation Perspective: A Brazilian Cross-Sectional Study
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Abstract
Nearly 40 years after the beginning of the HIV epidemic and the remarkable biomedical advances that have enabled people living with HIV (PLHIV) to achieve a good quality of life and increased life expectancy, research in developed countries continues to indicate a high frequency of psychopathology among this population. However, little is known about the mental health problems of PLHIV in underdeveloped or developing countries, such as Brazil. This study aimed to assess the frequency of symptoms of depression, anxiety, and stress among PLHIV and to evaluate possible differences in these mental health problems according to gender and sexual orientation. This cross-sectional, quantitative study assessed 91 individuals living with HIV (mean age = 46.82) in a specialized health service within the Brazilian public health system. Data were collected using the Depression, Anxiety, and Stress Scale (DASS-21) and through clinical record analysis. A high frequency of anxiety (45.16%, 95%CI: 34.81-53.83%), stress (37.89%, 95%CI: 28.1448.43%), and depression symptoms (29.35%, 95%CI: 20.31-39.76%) was found among participants. Being gay or bisexual was associated with higher levels of depressive symptoms and stress. No differences in psychopathology were found in terms of gender. Although the overall sample showed high rates of depression, anxiety, and stress symptoms, our findings indicate that gay and bisexual participants experienced greater severity of mental health problems.
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References
Alckmin-Carvalho, F., Pereira, H., Oliveira, A., & Nichiata, L. (2024). Associations between Stigma, Depression, and Adherence to Antiretroviral Therapy in Brazilian Men Who Have Sex with Men Living with HIV. European Journal of Investigation in Health, Psychology and Education, 14(6), 1489-1500. https://doi.org/10.3390/ejihpe14060098
Alckmin-Carvalho, F., Costa, Â. B., Chiapetti, N., & Nichiata, L. Y. I. (2023). Percepção de sorofobia entre homens gays que vivem com HIV. Revista Portuguesa de Investigação Comportamental e Social, 9(2), 1-16. https://doi.org/10.31211/rpics.2023.9.2.305
Alckmin-Carvalho, Felipe, Henrique Pereira, and Lucia Nichiata. (2024) “It’sa Lot of Closets to Come Out of in This Life”: Experiences of Brazilian Gay Men Living with Human Immunodeficiency Virus at the Time of Diagnosis and Its Biopsychosocial Impacts.” European Journal of Investigation in Health, Psychology and Education 14.4: 1068-1085. https://doi.org/10.3390/ejihpe14040070
Akyirem, S., Tong, G., Aidoo-Frimpong, G., Abwoye, D. N., Jacobson López, D., Wilton, L., & Nelson, L. E. (2024). HIV symptom clusters among sexual minority men in Ghana, West Africa: A cross-sectional study. The Journal of the Association of Nurses in AIDS Care. https://doi.org/10.1097/jnc.0000000000000497
Azhar, S., Jokhakar, V., Vaudrey, J., Gandham, S., Oruganti, G., & Yeldandi, V. (2023). Associations between HIV stigma, gender, and depression among people living with HIV in Hyderabad, India. Journal of Community Psychology, 51(3), 1060–1077. https://doi.org/10.1002/jcop.22934
Barradas, S. (2025). Associations Between Felt Stigma, Social Support, and Anxiety and Depression Symptoms in Adults Living with HIV. Trends in Psychology. https://doi.org/10.1007/s43076-025-00437-z
Benzaken, A. S., Pereira, G. F. M., Costa, L., Tanuri, A., Santos, A. F., & Soares, M. A. (2019). Antiretroviral treatment, government policy and economy of HIV/AIDS in Brazil: Is it time for HIV cure in the country? AIDS Research and Therapy, 16(1), 19. https://doi.org/10.1186/s12981-019-0234-2
Berlin, G., Dermody, S. S., Noor, S. W., Skakoon-Sparling, S., Ghauri, Y., Zahran, A., Card, K., Lachowsky, N., Cox, J., Moore, D. M., Lambert, G., Jollimore, J., Grace, D., Zhang, H., Apelian, H., Sang, J. M., Dvorakova, M., Lal, A., & Hart, T. (2024). Minority stress, psychological distress, sexual compulsivity, and avoidance-based motivations associated with methamphetamine use among sexual minority men living with HIV. Substance Use & Misuse. https://doi.org/10.1080/10826084.2024.2369159
Bernabe Jr, R. C., Regencia, Z. J. G., & Baja, E. S. (2022). Frequency of and factors associated with depressive and anxiety symptoms among people living with HIV infection in Davao City, Philippines. Southeast Asian Journal of Tropical Medicine and Public Health, 53(2), 123–141.
Brandelli Costa, A., Martins da Silva, M., Wiehe Chaves, L., Gelain, M., Graeff Bins-Ely, I., Alckmin-Carvalho, F., & Wendt, G. W. (2024). General and healthcare-related HIV stigma among cisgender Brazilian women: the role of socioeconomic vulnerability. HIV Research & Clinical Practice, 25(1), 2361179.
Brasil. (2018). Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos. Retrieved from http://vigilancia.saude.mg.gov.br/index.php/download/protocolo-clinico-e-diretrizes-terapeuticaspara-manejo-da-infeccao-pelo-hiv-em-adultos/?wpdmdl=6969 [Last accessed: 2025 Mar 5]
Brasil (2023). Ministério da Saúde; Secretaria de Vigilância em Saúde e Ambiente. Departamento de HIV, Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis Boletim Epidemiológico. Available online: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2023/hiv-aids/boletim-epidemiologico-hiv-e-aids-2023.pdf/view (accessed on 10 March 2025).
Brito, V. C. de A., Bello-Corassa, R., Stopa, S. R., Sardinha, L. M. V., Dahl, C. M., & Viana, M. C. (2022). Frequency of self-reported depression in Brazil: National Health Survey 2019 and 2013. Epidemiologia e Serviços de Saúde, 31, e2021384.
Costa, A. B., Bins-Ely, I. G., Penzato, V., Fontanari, A. M. V., Alckmin-Carvalho, F., Pereira, H. & Wendt, G. W. (2025). The impact of race, education, economic vulnerability, and stigma on viral load detectability among people living with HIV in Brazil. HIV/AIDS – Research and Palliative Care, 17, 241–249. https://doi.org/10.2147/HIV.S534526
Cherevko, O., & Mudrenko, I. (2024). Neurobiological, psychological, and sociodemographic predictors of mental disorders in HIV infection (literature review). Eastern Ukrainian Medical Journal, 12(1), 11–22. https://doi.org/10.21272/eumj.2024;12(1):11-22
Campos, L. N., Bonolo, P. F., & Guimarães, M. D. C. (2006). Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil. AIDS Care, 18(6), 529–536. https://doi.org/10.1080/09540120500221704
Campos, L. N., Guimarães, M. D. C., & Remien, R. H. (2010). Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS and Behavior, 14(2), 289–299. https://doi.org/10.1007/s10461-008-9435-8
Cunha, G. H., Fontenele, M. S. M., Galvão, M. T. G., Dantas, M. B., Gomes, M. E. C., Fechine, F. V., & Paiva, S. S. (2024). Factors associated with symptoms of anxiety and depression in people living with HIV in Northeast Brazil. Journal of Acquired Immune Deficiency Syndromes, 97(1), 87–98. https://doi.org/10.1097/QAI.0000000000003468
Den Boer, L. X. Y., Scheuermaier, K., Tempelman, H. A., Barth, R. E., Devillé, W. L. J. M., Coutinho, R. A., … Klipstein-Grobusch, K. (2025). The association of HIV status and depressive symptoms in the Ndlovu Cohort study. Scientific Reports, 15(1), 4539. https://doi.org/10.1038/s41598-025-85830-5
Filiatreau, L. M., Ebasone, P. V., Dzudie, A., Ajeh, R., Pence, B. W., Wainberg, M., … Parcesepe, A. M. (2022). Frequency of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. Journal of Affective Disorders, 308, 421–431. https://doi.org/10.1016/j.jad.2022.04.061
Fumaz, C., et al. (2019). Health-related quality of life of people living with HIV infection in Spain: a gender perspective. AIDS Care, 31(12), 1509-1517. https://doi.org/10.1080/09540121.2019.1597959
Garriga, C., et al. (2020). Psychological distress in women and men living with HIV in Spain: a cross-sectional telephone survey. Evidence-Based Mental Health, 23(2), 91-99. https://doi.org/10.1136/ebmental-2019-300138
Huang, Y., Luo, D., Chen, X., Zhang, D., Huang, Z., & Xiao, S. (2020). HIV-related stress experienced by newly diagnosed people living with HIV in China: A 1-year longitudinal study. International Journal of Environmental Research and Public Health, 17(8), 2681. https://doi.org/10.3390/ijerph17082681
Hunt, P. W. (2012). HIV and Inflammation: Mechanisms and Consequences. Current HIV/AIDS Reports, 9(2), 139–147. https://doi.org/10.1007/s11904-012-0118-8
Instituto Brasileiro de Geografia e Estatística. (2025). Cidades e Estados: Francisco Beltrão. Retrieved from https://www.ibge.gov.br/cidades-e-estados/pr/francisco-beltrao.html [Last accessed: 2025 Mar 8]
Joint United Nations Programme on HIV/AIDS. (2022). Fact Sheet 2022: Estatísticas Globais do HIV. Retrieved from https://unaids.org.br/wp-content/uploads/2022/07/2022_07_27_Factsheet_PT.pdf [Last accessed: 2025 Mar 5]
Joint United Nations Programme on HIV/AIDS. (2023). The Path That Ends AIDS: 2023 UNAIDS Global Aids Update. Retrieved from https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023 [Last accessed: 2025 Mar 9]
Krueger, E. A., Holloway, I., Lightfoot, M., Lin, A., Hammack, P. L., & Meyer, I. (2020). Psychological distress, felt stigma, and HIV prevention in a national probability sample of sexual minority men. LGBT Health. https://doi.org/10.1089/lgbt.2019.0280
Lam, A. A., Mayo, N., Scott, S., Brouillette, M., & Fellows, L. (2019). HIV-related stigma affects cognition in older men living with HIV. JAIDS Journal of Acquired Immune Deficiency Syndromes, 80, 198–204. https://doi.org/10.1097/QAI.0000000000001898
Leal, M., Kerr, L., Mota, R. M., Motta-Castro, A. R., Lima, L. N. C., Oliveira, L., Merchan-Hamann, E., Díaz Bermúdez, X. P., Pontes, A. K., Moreira, R. C., Guimarães, M., Brito, A., Dourado, I., Veras, M., Leal, A. F., Knauth, D., Macena, R. H., Brigido, L., & Magno, L. (2024). Increasing HIV Frequency rate among men who have sex with men: Results of a comparison of two national surveys. AIDS (London, England), 38, 1799-1801.https://doi.org/10.1097/QAD.0000000000003934
Lovibond, S. H., & Lovibond, P. F. (1996). Manual for the depression anxiety stress scales. Psychology Foundation of Australia.
Martins, R. S., Knauth, D. R., Vigo, A., & Fisch, P. (2023). Eventos marcadores associados à adesão ao tratamento para HIV/aids em um estudo de coorte [Marker events associated with adherence to HIV/AIDS treatment in a cohort study]. Revista de Saúde Pública, 57(1), 20. https://doi.org/10.11606/s15188787.2023057004219 [Article in Portuguese]
May, M. T., Gompels, M., Delpech, V., Porter, K., Orkin, C., Kegg, S., … Sabin, C. (2014). Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy: AIDS, 28(8), 1193–1202. https://doi.org/10.1097/QAD.0000000000000243
McKinnon, K., Alves-Bradford, J.-M. E., & Cournos, F. (2021). HIV and serious mental illness. In HIV Psychiatry (pp. 197–214). Springer. https://doi.org/10.1007/978-3-030-80665-1_12
Mello, V. A., Segurado, A. A., & Malbergier, A. (2010). Depression in women living with HIV: Clinical and psychosocial correlates. Archives of Women’s Mental Health, 13(3), 193–199. https://doi.org/10.1007/s00737-009-0094-1
Meng Li, C., Jie Ying, F., Raj, D., Pui Li, W., Kukreja, A., Omar, S. F., … Rajasuriar, R. (2020). A retrospective analysis of the care cascades for non-communicable disease and mental health among people living with HIV at a tertiary-care centre in Malaysia: Opportunities to identify gaps and optimize care. Journal of the International AIDS Society, 23(11), e25638.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Moges, N. A., et al. (2021). Psychological distress among newly diagnosed people living with HIV in Ethiopia. Infectious Diseases, 14. https://doi.org/10.1177/1178633721994598
Mommersteeg, P., et al. (2023). Gender roles and norms associated with psychological distress in women and men. Journal of Health Psychology. https://doi.org/10.1177/13591053231207294
Dave, P. (2024). The correlation between stigma and mental health disorders in people living with HIV/AIDS. Journal of Drug Delivery and Therapeutics. https://doi.org/10.22270/jddt.v14i3.6490
Nakimuli-Mpungu, E., Musisi, S., Smith, C. M., Von Isenburg, M., Akimana, B., Shakarishvili, A., … Joska, J. A. (2021). Mental health interventions for persons living with HIV in low- and middle-income countries: A systematic review. Journal of the International AIDS Society, 24(S2), e25722. https://doi.org/10.1002/jia2.25722
Niu, L., Luo, D., Liu, Y., Silenzio, V. M., & Xiao, S. (2016). The mental health of people living with HIV in China, 1998–2014: A systematic review. PloS One, 11(4), e0153489.
Nogueira, L. F. R., Pellegrino, P., Duarte, A. de S., Inoue, S. R. V., & Marqueze, E. C. (2019). Common Mental Disorders are associated with higher viral load in People Living with HIV. Saúde Em Debate, 43, 464– 476. https://doi.org/10.1590/0103-1104201912114
Nomoto, S. H., Longhi, R. M. P., de Barros, B. P., Croda, J., Ziff, E., & Konkiewitz, E. C. (2015). Socioeconomic disadvantage increasing risk for depression among recently diagnosed HIV patients in an urban area in Brazil: Cross-sectional study. AIDS Care, 27(8), 979–985. https://doi.org/10.1080/09540121.2015.1017442
Pinho, C. S. N., Santana, R. D., Campos, E. D. M., & Pires Neto, R. D. J. (2022). Prevalence and factors associated with depression in people living with HIV/AIDS in a Brazilian metropolitan region. AIDS Care, 34(12), 1580–1585. https://doi.org/10.1080/09540121.2022.2100866
Reis, R. K., Melo, E. S., Castrighini, C. C., Galvão, M. T. G., Toffano-Santana, S. E., & Gir, E. (2017). Prevalence and factors associated with depressive symptoms in individuals living with HIV/AIDS. Salud Mental, 40(2), 57–62. https://doi.org/10.17711/SM.0185-3325.2017.008
Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Degen, O., … Janeiro, N. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. The Lancet, 393(10189), 2428–2438. https://doi.org/10.1016/S0140-6736(19)30418-0
Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Degen, O., Corbelli, G. M., Estrada, V. P., Geretti, A. M., Beloukas, A., & Lundgren, J. D. (2016). Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 316(2), 171–181. https://doi.org/10.1001/jama.2016.5148
Santana, R. D., Pinho, C., Pinheiro Júnior, F. M. L., Bezerra, F. M., Cavalcante, M. G., Campos, E. M., & Neto, R. (2019). Prevalence and factors associated with the generalized anxiety disorder among people living with HIV/AIDS in Brazilian outpatient clinics. Revista de Medicina da UFC, 59(3), 32–38. https://doi.org/10.20513/2447-6595.2019v59n3p32-38
Safren, S. A., O’Cleirigh, C., Andersen, L. S., Magidson, J. F., Lee, J. S., Bainter, S. A., … Joska, J. A. (2021). Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha, South Africa: A randomized controlled trial. Journal of the International AIDS Society, 24(10), e25823.
Silva, I. B. D. N., Azevedo Minhaqui Ferreira, M., Patrício, A. C. F. D. A., Rodrigues, B. F. L., Brasil, M. H. F., Nascimento, J. A., & Da Silva, R. A. R. (2021). Depressão e ansiedade de pessoas vivendo com HIV. Revista Contexto & Saúde, 21(44), 322–331. https://doi.org/10.21527/2176-7114.2021.44.9528 [Article in Portuguese]
Stein, J. H., & Hsue, P. Y. (2012). Inflammation, Immune Activation, and CVD Risk in Individuals With HIV Infection. JAMA, 308(4), 405. https://doi.org/10.1001/jama.2012.8488
Trickey, A., Sabin, C. A., Burkholder, G., Crane, H., d’Arminio Monforte, A., Egger, M., … Sterne, J. A. C. (2023). Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: A collaborative analysis of cohort studies. The Lancet HIV, 10(5), e295–e307. https://doi.org/10.1016/S2352-3018(23)00028-0
Vignola, R. C. B., & Tucci, A. M. (2014). Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. Journal of Affective Disorders, 155, 104–109. https://doi.org/10.1016/j.jad.2013.10.031
Zungu, N., et al. (2023). Determinants of gender disparities in psychological distress among youth and adults in South Africa. medRxiv. https://doi.org/10.1101/2023.08.11.23293980
World Health Organization. (2024). HIV/AIDS - 2024. Retrieved from https://www.who.int/news-room/factsheets/detail/hiv-aids [Last accessed: 2025 Feb 27]