Psilocybin-assisted therapy and HIV-related shame

HIV-related shame predicts substance use and poor antiretroviral adherence among people with HIV, hindering national epidemic-ending goals. In a pilot clinical trial with 12 participants, psilocybin-assisted group therapy produced a large decrease in HIV-related shame, with a median reduction of 5.5 points on the HIV and Abuse Related Shame Inventory from baseline to 3-month follow-up. However, two participants experienced a paradoxical worsening of sexual abuse-related shame after psilocybin, raising concerns about its use in patients with trauma. These preliminary results suggest potential for addressing HIV-related shame but highlight cautions.

Study at a glance

Abstract

Abstract As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic , in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of − 5.5 (− 6.5, − 3.5) points from baseline to 3-months follow-up ( Z = − 2.6, p = 0.009, r = − 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.