Depression & HIV

Every Forty Seconds
We need to raise awareness about the other epidemic—depression
by Joshua Middleton

I am HIV-positive and, yes, I also live with depression. That’s right, I said it. The big “D” word that no one wants to say. Let me share with you my perspective on an epidemic possibly far bigger than any we have ever faced before.

Joshua bicycled across the Golden Gate on a recent trip to San Francisco. Photo courtesy J. Middleton
Joshua bicycled across the Golden Gate on a recent trip to San Francisco. Photo courtesy J. Middleton

On a recent trip, as I bicycled over the Golden Gate Bridge, the reality of what has become such a taboo subject really hit home. The architectural masterpiece that is visited by swarms of tourists a year also sits above a graveyard where thousands have succumbed to the seemingly neverending battle with mental health issues, namely depression.

Just as the marine layer began to lift, I peered over to my right towards another iconic Bay Area piece of history, the infamous Alcatraz Prison. Imagine being imprisoned in such a place. Four walls confining you from freedom with only a glimpse of the outside world. A place that has entrances and exits but, despite knowing how to get out, you can’t seem to accomplish it. Happiness and joy are taken from you and the reality is the vastness of time that is ahead of you. It seems you are just going through the motions. The worst part of it is, no one talks about what you are going through; it’s as if you don’t exist. You are left with a feeling of isolation, cast out from society. Now you know what it is like for someone who lives with depression.

Ironically, both are located in San Francisco, a city that has been majorly affected by the virus since the beginning of the AIDS epidemic. Although some statistics show that sixty percent of individuals who are living with HIV are also living with depression and that we are three times more likely to become depressed, society as a whole doesn’t care to talk about it. It’s uncomfortable, awkward, and foreign to those who haven’t experienced it.

Its effects on someone living with HIV range from the extreme cases of suicide to other issues such a decline in treatment adherence, substance abuse, and an overall reduction to quality of life.

Did you know that suicide is a leading cause of death? In 2014 alone there were over one million deaths a year, which breaks down to one death by suicide approximately every forty seconds. In two-thirds of the cases, depression was an underlying factor at the time they ended their lives. By the time you finish reading this article theoretically five more will be gone because they couldn’t hold on any longer. They were strong for far too long.

That’s right, strong. You didn’t misread and no it wasn’t a typo. Enduring depression takes strength. It’s not a sign of weakness and it’s the very stigma that tells us these things that is keeping many in the shadows of silence. We need a new approach to how we look at this condition. We need to encourage people to speak up and seek help whenever possible.

How can we expect people to adhere to treatment when taking a pill appears as difficult as climbing a mountain? Why would substance abuse not be on the rise when people are feeling so low in their lives that they find a way to get a temporary high and mask their pain? How can we tell people to look at the positives in life when the world seems to be crumbling before them?

Understandably, HIV is a life-changing diagnosis. It’s a virus that has been stigmatized from the very beginning and for various reasons it can trigger depression. Integral care of both physical and mental health from the beginning of diagnosis is vital. There is help out there, but people will only reach out for it when they are ready but are often held back by the stigma.

What can you do to help someone with depression? Listen. Yes, it’s that simple. Realize that a nonjudgmental and impartial ear is crucial. One that isn’t there to offer unwanted opinions or advice but just to offer an open line of communication and give a hug when needed. With this one simple step. you have validated someone’s feelings in knowing that there is no shame in saying, “I have depression and it’s okay to talk about it.”

If we are serious about reaching our goal of zero then we must start by talking about depression!

Change starts with a conversation and recognition of the problem—it starts here!

Are you in search of mental health/substance abuse services? Call SAMHSA National Hotline toll-free at 1 (800) 662-HELP. Are you experiencing a mental health crisis right now or feeling suicidal? Need someone to talk to? Please call toll-free 1 (800) 273-8255.

Joshua is a social media blogger, educator, and public speaker who advocates for HIV and mental health awareness. As someone living with HIV and depression himself, he knows how hard it can be, but he also firmly believes in the impact of relating to and supporting one another through sharing his own personal journey with the world. He helps inspire hope in others through his blog,, by consistently showing people that “the sky is the limit: there is life beyond HIV.”