The links between HIV and depression are well established. HIV-positive people do have higher rates of depression than the general population.
But key findings from an Australian research project by the Centre for Social Research in Health (formerly the National Centre in HIV Social Research) have added considerably to what’s now known about the experience of HIV and depression in gay men. It unpacks some of the complex interactions between depression, sexuality and HIV infection.
"And then throw HIV into this equation . . . where people still don’t deal well with it or people who’ve had it for a long time haven’t . . . you know . . . are still adjusting to what it means and all the noise around it. All the confusion and talk – one person thinks this and one person doesn’t think this. One person wants you to fuck them dead without anything and the other person is freaking out because they think you have everything under the sun. And it’s like . . . who do you listen to? And when do you, how do you find the stillness to just sit in your identity and move on from there? To me, it’s just a cocktail for craziness at the moment." Lucian 44, HIV positive
The findings come from interviews with GPs and their patients – both positive and negative gay men attending high HIV-caseload general practice clinics in Sydney, Adelaide and a coastal town in New South Wales.
Partners in the project were drawn from general practice, research, mental health and national community organisations. This multi-disciplinary approach meant we were more quickly able to translate the research findings into useful tools for doctors to diagnose depression and for patients to manage it.
The research confirmed that gay men have high rates of depression – more than 30% for those with HIV and 20% for those without. The most likely causes related to marginalisation and discrimination, often described by the men in the study as "not fitting in". Personal withdrawal, socio-economic hardship and interpersonal isolation were most significantly and independently associated with major depression.
Multiple losses increase both the risk of depression as well as its severity. Many positive gay men have lost relationships and social connectedness, career and earning capacity, a sense of future and longevity.
Key events such as a positive diagnosis, the need to start antiretroviral therapy, treatment failure, an AIDS-defining illness, or a friend’s AIDS-defining illness were identified by GPs as additional triggers that increased their vigilance and awareness of depression. This was especially the case for men who have been living with HIV for a long time.
So what can we do to help manage our depression?
One place to start is with the online modules on the 'This way up' website. The Clinical Research Unit for Anxiety and Depression (CRUfAD) based at St Vincent’s Hospital in Sydney maintains the website for people with anxiety and depression.
If this interests you, then access the online depression selfmanagement tool at www.https://thiswayup.org.au/self-help/courses/