Psilocybin-assisted therapy and HIV-related shame

Introduction

While antiretroviral therapy has transformed HIV into a manageable chronic condition, people with HIV (PWH) in the United States continue to experience high rates of psychological distress and substance use disorders. The paper frames shame—an intensely painful inward-focused emotion involving negative self-evaluation—as a key mediator linking stigma-related environmental stressors to adverse mental and physical health outcomes among PWH, including depression, PTSD, substance use, poor ART adherence and worse physical health via stress-related biological pathways. Shame is described as more deeply ingrained than guilt and therefore difficult to address with conventional psychotherapies, which can be time-consuming and require sustained engagement that shame itself can impede. This study aimed to explore whether psilocybin-assisted psychotherapy could reduce HIV-related and sexual abuse-related shame. The intervention combined group-based preparatory and integration therapy with a single open-label, individually dosed psilocybin session. The authors focused on a specific population—gay-identified, older, long-term AIDS survivor men—and conducted exploratory analyses of changes in shame from baseline to three months after dosing, noting that no prior studies had formally evaluated psychedelic therapies for shame and that this trial is the only interventional study to date explicitly examining psychedelics in sexual and gender minority (SGM) patients with HIV.