Quick summary: Anxiety affects around 36% of people living with HIV in India, a rate far higher than in the general population and one that remains largely overlooked in routine care. Untreated anxiety undermines antiretroviral adherence and overall health outcomes, placing extra strain on both patients and services. Making anxiety screening standard in HIV clinics, with better mental health integration and support, would improve well-being and treatment success for thousands across the country.
A major new analysis has found that anxiety affects roughly 1 in 3 people living with HIV in India, a figure far higher than rates seen in the general population. The findings point to a mental health burden that remains largely overlooked within HIV care services across the country.
The systematic review and meta-analysis, published in the Indian Journal of Psychiatry, pooled data from 15 studies involving 5,336 people living with HIV across states including Maharashtra, Karnataka, Tamil Nadu and West Bengal. Researchers calculated an overall pooled prevalence of anxiety of 36%, compared with the 3.3% to 3.5% prevalence of neurotic and stress related disorders reported in India’s general population by earlier national surveys.
The research team, led by Aninda Debnath and colleagues from the All India Institute of Medical Sciences and the National Institute of Mental Health and Neurosciences, examined studies published up to November 2024. Anxiety rates were higher among people attending hospital based clinics, at 39%, compared with 23% in community settings, though the difference was not statistically significant.
The choice of screening tool strongly influenced results. Self report questionnaires such as the Hospital Anxiety and Depression Scale and the Depression Anxiety and Stress Scale produced estimates of 48% to 49%. Structured clinical interviews based on formal diagnostic criteria gave much lower figures, with the ICD-10 interview at 7% and the DSM-IV interview at 1%. The authors note that self report scales may capture general distress rather than clinically diagnosable anxiety.
Laurie Groh, MS, owner of Shoreside Therapies, said: “I’m not surprised by self-reports being different from a formal diagnostic assessment. Self-reports tend to be higher because somebody may be experiencing anxiety in a way that might not be concretely diagnostic. Screening tools tend to cast a wider net, and having a diagnosable mental health issue typically means that it is of a more extreme nature. But that doesn’t mean help should not be provided, because getting treatment before it becomes a crisis is helpful and makes treatment easier.”
Women showed a higher pooled prevalence than men, at 46% compared with 36%, though the gap was not statistically significant. Higher rates of depression within study populations were strongly linked to higher anxiety prevalence.
Stigma surrounding both HIV and mental illness creates a particular burden, while limited access to mental health services, especially in rural areas, compounds the problem. Anxiety screening in HIV clinics currently lags far behind screening for depression.
The study calls for anxiety screening to become routine in HIV care, alongside stigma reduction and approaches tailored to women’s needs. Michael J. Zizmor, MD, of Zizmor Mental Health in Berkeley, California, explained: “Screening for anxiety is not yet a standard procedure. The guidelines for HIV care already put forward the GAD-2 or GAD-7 as recommended tools, so putting these brief, validated instruments to use would be a sensible way to address the gap. What is required is a better integration of mental health into the existing HIV treatment framework, with swift referrals and interventions. Given the shortage of trained professionals, it would make sense to have counsellors on hand at the clinic to offer stepped-care for mild depression or anxiety during a routine visit.”
Left untreated, anxiety has been linked to poorer adherence to antiretroviral treatment and worse health outcomes, making early identification a priority.
