The association between internalized HIV stigma, depression, and anxiety among young people living with HIV affected by resilience and self-esteem as mediators

Adolescents and young adults living with HIV aged 15-24 years face an increased risk of mental health problems. This study examined the association between internalized HIV stigma and depression among young people living with HIV and explored whether resilience and self-esteem mediate this relationship. A cross-sectional survey was conducted with 120 participants aged 15-24 years receiving outpatient care at a tertiary care center in Bangkok, Thailand. Participants completed validated Thai versions of the PHQ-9, GAD-7, Internalized HIV Stigma Scale, Rosenberg Self-Esteem Scale, Connor-Davidson Resilience Scale, and sociodemographic questionnaires. Mediation analysis was performed using a bootstrapping method. Overall, 21.7% of participants reported depressive symptoms and 13.3% reported anxiety. Higher internalized stigma was directly and indirectly associated with higher depression scores (β = .083, 95% CI [.017, .149]; β = .066, 95% CI [.026, .126]) and anxiety scores (β = .074, 95% CI [.017, .13]; β = .056, 95% CI [.03, .099]) through resilience and self-esteem in a serial mediation pathway. Findings indicate that stigma adversely influences mental health among young people living with HIV, with resilience and self-esteem serving as protective mediators. Interventions that address stigma and strengthen resilience and self-esteem, particularly during adolescence and emerging adulthood, may help mitigate adverse mental health outcomes in this vulnerable population.