Predictors of depressive symptoms among people living with HIV in India: the role of internalized stigma.

We analyzed data from 526 people living with HIV (PLWH) enrolled in the Tel-Me-Box study across two urban ART clinics in Karnataka, India, followed for 24 months. Depressive symptoms, internalized HIV stigma, sociodemographic variables, disclosure status, number of physical symptoms, employment status and household income were assessed at baseline, 6, 12, 18 and 24 months. We used logistic regression for repeated measures to examine concurrent and time-lagged associations, adjusting for time-invariant and time-varying predictors. At baseline, the mean age of participants was 39.5 years, half (50.8%) were female, 14.8% reported at least mild depressive symptoms, and the mean number of physical symptoms reported was three. The mean internalized HIV stigma score was 0.52 (range 0-3). In multivariable analyses, internalized HIV stigma (Concurrent analysis: adjusted odds ratio (AOR) 2.23, 95% CI 1.81-2.73, p < 0.001; Lagged analysis: AOR = 1.61; 95% CI 1.30-1.99; p < 0.001) and the number of physical symptoms (Concurrent analysis: AOR 1.68, 95% CI 1.57-1.79, p < 0.001; Lagged analysis: AOR = 1.32; 95% CI 1.23-1.42; p < 0.001) were significantly associated with depressive symptoms. Therefore, internalized HIV stigma independently predicts depression among PLWH in southern India.