TOPLINE

Among African American/Black and Hispanic/Latina women living with HIV during the COVID pandemic, those who had been living with HIV for 15 years or longer had nearly four times the odds of mild-to-severe depression as opposed to those who had been living with HIV for less than 15 years. Self-silencing — suppressing thoughts and emotions to preserve relationships — was strongly associated with the odds of depression, particularly among long-term survivors.

METHODOLOGY

• This cross-sectional study estimated the prevalence of resilience, self-silencing, depression, and antiretroviral treatment adherence among racially and ethnically minoritized women living with HIV during the COVID pandemic and examined the associations of these psychosocial factors with each other and with pandemic-related stress.
• They included 85 women (mean age, 37.1 years) who self-identified as African American/Black or Hispanic/Latina, had confirmed HIV infection, and were receiving care at a public HIV clinic in Los Angeles from September 2021 to May 2023.
• COVID history was self-reported, and 41% of the participants reported a prior diagnosis.
• Participants completed staff-administered questionnaires that included demographic and clinical questions and validated measures of antiretroviral treatment adherence, resilience, depression, and self-silencing.
• Three open-ended questions captured participants' emotional experiences, pandemic-related challenges, and coping strategies during the COVID pandemic.

TAKEAWAY

• Overall, 33% of the participants had low resilience, 25% screened positive for mild-to-severe depression, and 36% reported low antiretroviral treatment adherence; the mean self-silencing score was 66.2 on a scale ranging from 35 to 155, with higher scores indicating greater levels of self-silencing.
• Self-silencing was positively associated with depression (adjusted odds ratio [aOR], 1.08; P = .0067), with the association significant only among women living with HIV for 15 years or more (P = .0002).
• Living with HIV for 15 years or longer was associated with nearly four times the odds of depression relative to living with HIV for less than 15 years (aOR, 3.92; P = .043). The association between the duration of living with HIV and the depression was stronger among participants with a prior COVID diagnosis (P = .02).
• In open-ended responses, 84% of the participants described sadness, depression, or loneliness, and 67% described stress, anxiety, or fear. Financial or job insecurity was the most commonly reported practical challenge (reported by 60% of the participants). The most common coping strategies were reliance on family or social support and engagement in spirituality or faith-based practices, reported by 61% and 43% of the participants, respectively.

IN PRACTICE

"These results point to the need for HIV care models that move beyond clinical indicators to incorporate trauma-informed, culturally responsive approaches that explicitly address emotional expression, relational dynamics, and sustained psychological adaptation over time," the authors wrote.

SOURCE

The study was led by Mariam Davtyan, University of Southern California, Los Angeles. It was published online on September 7, 2026, in AIDS Care.

LIMITATIONS

The cross-sectional design limited causal inference. The sample was drawn from a single clinical site and included only women who were engaged in care or reachable for participation, potentially limiting the generalizability of the findings. Moreover, self-report measures may be affected by social desirability or recall bias, and some associations were not statistically significant, possibly reflecting limited statistical power.

DISCLOSURES

This study was funded by the University of Southern California's Strategic Directions for Research Award. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.