Psychosocial Determinants of Mental Health in Older Adults Living With HIV: The Protective Role of Resilience Against Internalized Stigma.

Abstract

Despite comprising nearly one in 10 people living with HIV (PLHIV) in Brazil, older adults aged 60 years and above remain profoundly underrepresented in psychosocial research. This multicenter study is the first age-restricted (≥ 60 years) subgroup analysis of the Brazilian PLHIV Stigma Index 2.0. The present secondary analysis yielded a sample of 138 older adults (M age = 64.3 years, SD = 4.1; 52.9% male; 57.2% Black or Brown). Path analysis with 5000-resample bootstrapping and full-information maximum likelihood estimation confirmed a statistically significant indirect effect of general stigma on depression mediated by internalized stigma (indirect effect = 0.087, 95% CI [0.037, 0.173], p = 0.009), with no significant direct pathway (c' = 0.058, p = 0.324). A parallel model confirmed that internalized stigma also mediated the effect of general stigma on anxiety (indirect effect = 0.071, 95% CI [0.029, 0.146], p = 0.012). A moderated mediation model testing whether resilience buffers the stigma-internalization pathway found that resilience did not significantly moderate the a-path (interaction b = 0.003, p = 0.817) but maintained a significant inverse main effect on internalized stigma (b = -0.091, p = 0.014), supporting an upstream rather than buffering mechanism. Complementary network analysis using regularized partial correlations (EBICglasso) confirmed internalized stigma as the dominant psychosocial hub (strength centrality = 0.896). Network predictability was highest for depression (R ² = 0.41) and internalized stigma (R² = 0.32). Neither age nor time since diagnosis independently predicted psychological distress. These findings support a mechanistic model in which internalized stigma mediates the effect of social discrimination on both depressive and anxious symptomatology, and resilience acts as an upstream protective factor. Stigma-focused, resilience-building, and aging-sensitive psychosocial interventions are indicated as priority components of HIV care for aging populations.