HIV & Depression

 How Long-Term HIV Survival and Depressive Episodes Go Hand-In-Hand

Living with HIV for decades turns time into something strange. The urgency of the early years eventually fades, but the virus doesn’t. It just settles in, like a roommate you never invited and can’t evict. The crisis slowly becomes routine, and routine becomes its own kind of prison. That little pill that keeps me alive is both my miracle and my mirror—every morning it reflects back the part of me I’d most like to erase. I swallow it with water and a wince, a daily ritual of gratitude and resentment in the same breath.

What people don’t always see is that long-term survival comes with a quiet, grinding grief. I outlived the panic-era headlines, the funerals, the whispered “Did you hear…?” phone calls—but survival has a body count, and sometimes I feel like I’m standing on top of it. Survivor’s guilt isn’t just a dramatic phrase; it’s the heaviness you feel when you realize you’re still here while faces you loved live only in old photos and half-faded memories. You start to wonder why you were spared—what cosmic math decided you get to grow older with this virus while others never had the chance. The world moved on to new scandals and new crises, but my body never got to move on from this one.

Then there’s the stigma that doesn’t die, it just evolves. It lives in the awkward pause when I disclose my status. In the way some people say “Oh… thank you for telling me,” like I just handed them a ticking bomb instead of a piece of my truth. It’s in the dating apps where you either brand yourself with three letters—HIV—or play this exhausting game of timing and disclosure and risk. Even in 2025, with PrEP and U=U and all the science in the world, there are still looks, still questions, still people who treat you as a walking warning label instead of a whole person.

Sex, for me, isn’t a minefield of disclosure anymore; I took that part out of the equation a long time ago. My status is right there on every profile, in plain sight, so anyone who can’t handle it can quietly move along before we ever exchange a word. It’s a kind of harm reduction for the heart: I don’t have to brace for the awkward pause, the panicked unmatch, the “sorry, I didn’t realize…” message. But there’s a quieter cost to that system too. I never see the rejections—I just feel the absence. Fewer messages, fewer replies, conversations that die on the vine. You can’t prove it’s because of those three letters, but you feel it anyway. It becomes easy to see yourself less as a person who happens to have HIV and more as a filter people are silently passing or failing before they ever bother to meet you.

Over time, that kind of invisible sorting seeps into the bedroom, even when I’m with someone who does show up, who does understand U=U, who doesn’t flinch at my status. My body still remembers years of being treated like a risk instead of a partner. Desire gets tangled up with self-consciousness, with side effects, with the sense that I’m a “safer choice” only because I’ve turned my sex life into a disclaimer-first operation. It’s not that I’m afraid to be honest; it’s that honesty has taught me exactly how conditional other people’s desire can be — and some days my libido responds by just shutting the whole system down.

Depression doesn’t just drain my mood; it interferes with the one thing that’s literally keeping me alive. When I fall deep into an episode, basic tasks turn into impossible mountains. Getting out of bed feels like a negotiation. Feeding myself, brushing my teeth, taking a shower—those start to feel optional. The pill bottle on the nightstand stops looking like hope and starts looking like a judgmental little witness. On the worst days, I just roll over and let the hours pass, doses slipping by untouched. It’s not always a dramatic “I want to die.” Sometimes it’s just a quiet “I don’t care what happens to me right now,” and that indifference is its own kind of danger.

That’s what scares me when I finally surface: how easily survival can start to unravel in those stretches. If I miss meds for long enough, HIV stops behaving like a managed chronic condition and starts becoming a real threat again. The virus I work so hard to keep caged gets a chance to wake back up. Then the shame hits: You know better. How could you let this slide? That shame folds right back into the depression, which makes it even harder to pick the pill up the next day. It becomes a loop—virus, pill, depression, avoidance, more risk—and it’s terrifying to realize how quickly that loop could become deadly if it goes unchecked.

From the outside, it just looks like I’m “having a rough week” or “in a funk.” Nobody sees the small, lethal math happening in my bedroom: missed pills, skipped meals, a body quietly absorbing every choice I’m too numb to make. Long-term survival is sold as lab numbers and adherence charts, but for me it’s also this constant fight not to let the darkness talk me out of basic self-care. The same daily pill that gave me a future back can become the first thing I stop reaching for when the future feels too heavy to hold.

And yet, here I am. Still taking the pill. Still doing the laundry. Still paying bills, going to work, flirting on good days, hiding on the bad ones. That’s the darker side of survival no one prepared me for: not the drama of dying, but the discipline of living. Waking up again and again to the same virus, the same bottle, the same history, and choosing—sometimes reluctantly, sometimes angrily—to keep going. It isn’t inspirational. It isn’t neat. It’s just real.