Association between sexual orientation and depression among male patients with HIV: a cross-sectional study

Background Depression is a prevalent comorbidity among people living with HIV (PLWH) and is associated with poorer clinical outcomes. Sexual minority men may face unique psychosocial stressors that increase vulnerability to depression. This study aimed to investigate the association between sexual orientation and depression among male patients with HIV in Suqian, China. Methods A cross-sectional study was conducted among 163 male HIV-positive patients. Sexual orientation was self-reported as heterosexuality or homosexuality. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), analyzed both as a continuous variable and as a categorical variable (PHQ-9 ≥ 10 indicating depression). Four multivariable regression models were constructed with progressively adjusted covariates: Model 1 (unadjusted), Model 2 (sociodemographic factors), Model 3 (lifestyle factors), and Model 4 (clinical factors). Results Among 163 participants, 91 (55.8%) identified as heterosexual and 72 (44.2%) as homosexual. Homosexual participants were significantly older (63.85 ± 12.63 vs. 46.53 ± 10.07 years) and had higher depression prevalence (22.2% vs. 11.0%). In the fully adjusted model (Model 4), homosexuality was significantly associated with increased odds of depression (OR = 4.45, 95% CI: 1.43–15.58, p = 0.013). The association remained consistently positive across all models, though statistical significance for the continuous PHQ-9 outcome was marginal (β = 1.84, 95% CI: −0.10 to 3.78, p = 0.063). Conclusion Homosexual orientation is independently associated with higher depression risk among male HIV patients, highlighting the need for tailored mental health screening and interventions for sexual minority men in HIV care settings.