Hopelessness and HIV infection: an exploratory study with a gender-specific perspective

Lena Nilsson Schönnesson, Michael W. Ross, Diego Garcia-Huidobro, Lars E. Eriksson, Galit Andersson, Mark L. Williams, Anna Mia Ekström

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Background: An understudied psychological response to HIV-related stressors among people living with HIV is hopelessness. Hopelessness is the expectation that things will not improve and feeling helpless to change one’s current situation. The aim of this study was to assess prevalence and levels of hopelessness and its direct and indirect contributors in people living with HIV in Sweden. Methods: Participants included 967 women and men from the “Living with HIV in Sweden” cross-sectional study with available data regarding hopelessness measured by the Beck Hopelessness Scale. Binary and multiple logistic regression analyses were used to determine direct and indirect factors that may contribute to feelings of hopelessness. Path analyses were used to assess the underlying structure of hopelessness. All analyses were conducted by gender. Results: Almost half the participants reported moderate to severe hopelessness. There were no differences in frequency of feeling hopeless or level of hopelessness by gender or sexual orientation. Dissatisfaction with finances, dissatisfaction with physical health, and low HIV-related emotional support were found to be directly associated with hopelessness for both women and men. Although having some indirect factors in common, unemployment and HIV stigmatization, women and men had different underlying structures of hopelessness. Conclusions: Our findings are important to HIV clinicians in identifying those at risk of hopelessness from a gender perspective in order to reduce preventable psychological distress among people living with HIV.

Original languageEnglish (US)
Article number46
JournalBMC Psychology
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
For men, three factors were indirectly associated with feelings of hopeless: born outside Sweden, time since HIV diagnosis, and dissatisfaction with one’s openness about HIV. There were two indirect paths from born outside Sweden to hopelessness. The strongest was to age, suggesting foreign born men may have been younger than Swedish born men living with HIV. This is supported by the Swedish HIV statistics []. The other indirect path from born outside Sweden was to dissatisfaction with finances. Migrants in Sweden are often economically more vulnerable than Swedish-born citizens []. Their financial hardship may be indicative of the combination of migration and HIV status, suggesting being a migrant indirectly increases psychological distress [, , ]. In contrast to Stanley et al.’s study [], time with diagnosed HIV infection had a strong indirect effect on hopelessness through age. Older men were likely to have been diagnosed with HIV infection for more than 10 years, signifying they may have ongoing health problems or disability related to HIV infection []. The indirect path from time since HIV diagnosis to financial dissatisfaction was weak, but may reflect increased time living with HIV has had its toll on the financial situation. Dissatisfaction with one’s openness about HIV had a weak association through low HIV-related emotional support to feelings of hopelessness.

Publisher Copyright:
© 2022, The Author(s).


  • Contributors
  • Gender differences
  • Hopelessness
  • People living with HIV
  • Sweden

PubMed: MeSH publication types

  • Journal Article


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