HIV Stigma, Perceived Social Support and Secrecy Strategies: Three Key Aspects of Mental Health Nursing for Individuals Living With HIV and Depression

INTRODUCTION: Understanding the psychosocial factors behind depression in people living with HIV is crucial for improving mental health nursing practice and related treatment outcomes. AIM: To examine the psychosocial variables and underlying mechanisms affecting depression in HIV-positive individuals. METHODS: The study utilised a cross-sectional design and administered a self-reported survey among 429 individuals living with HIV. Depressive symptoms, HIV stigma, perceived social support and preoccupation with secrecy were assessed using the Nine-item Patient Health Questionnaire, Berger HIV Stigma Scale, Medical Outcomes Study-Social Support Survey, and Preoccupation with Secrecy Survey, respectively. Descriptive, correlational and bootstrap-based path analyses were conducted using SPSS version 26.0. RESULTS: Of the participants, 52% reported mild or above depressive symptoms. HIV stigma was associated with depression, and this relationship was mediated by perceived social support and preoccupation with secrecy. Specifically, the mediation model revealed three pathways: (1) the independent mediating effect of perceived social support (effect size = 0.077); (2) the independent mediating effect of preoccupation with secrecy (effect size = 0.161); and (3) the chain mediating effect of perceived social support and preoccupation with secrecy (effect size = 0.011). Notably, pathway 2 exhibited the largest relative effect (64.7%), followed by pathway 1 (30.9%) and pathway 3 (4.4%). DISCUSSION: This study clarifies the pathway from HIV stigma to mental health, informing focused nursing strategies. Key nursing actions include fostering a non-judgemental environment that encourages the observation and expression of feelings without criticism and is centred on understanding and acceptance, facilitating access to social support, and utilising techniques such as distraction, self-affirmation or art-based activities. Furthermore, nursing administrators should prioritise resource allocation and training to build a supportive care system. CONCLUSION: HIV stigma, perceived social support and secrecy strategies should be integrated into mental health nursing for depressed individuals living with HIV. LIMITATIONS: This study was limited to the individual level and did not examine broader sociocultural factors or the intersection of HIV stigma with other forms of identity-based stigma. IMPLICATIONS: This study demonstrates the necessity and feasibility of integrating psychosocial assessment and intervention into HIV-related nursing, offering empirical basis for optimising clinical practice, refining related training and informing policy development. RECOMMENDATIONS: It is recommended to establish a multidisciplinary team-based service model that integrates psychosocial support into HIV care.