Online mindfulness audio lessons can significantly reduce depression, anxiety and loneliness in older people with HIV, according to a randomised study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2021). This may be the first time that such effect is demonstrated by research.

Older adults living with HIV often experience high levels of depression, anxiety and loneliness. Some evidence suggests that online mindfulness lessons may ease these problems and enhance access to mental health care. This may be especially true in the context of COVID-19 lockdowns and restrictions.

Mindfulness is a type of meditation in which you focus on being intensely aware of what you're sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.

Previous research had shown that the mindfulness lessons helped with depression, anxiety and loneliness in adults with elevated stress levels in the general population.

What impact might online mindfulness lessons have on depression, anxiety and loneliness among older adults living with HIV? Jeff Berko, Director of Research at Mazonson and Santas – a health consulting company – and colleagues from US universities, medical centres and ViiV Healthcare conducted a study to answer this question.

The study

The study was built on the foundation of an observational cohort study of people living with HIV in the United States over the age of 50, launched in 2018. Participants completed questionnaires covering many issues, from activities to well-being, medication adherence and housing.

By early 2020, 1047 responses had been received. They showed that 21% of participants suffered from depression, 21% from anxiety and 51% from loneliness.  Categories were not mutually exclusive. For example, 16% of participants were both depressed and anxious. The investigators were aware that COVID-19 control measures might exacerbate these issues.

The randomised controlled trial was conducted between May and August 2020, during the COVID-19 epidemic. It compared online mindfulness audio lessons to no intervention in cohort members. There were three outcomes of interest:

  • Depression – measured with the Centre for Epidemiologic Studies Depression Scale (CES-D-10) on a range from 0 to 30.
  • Anxiety – measured with the Generalised Anxiety Disorder (GAD-7) on a range from 1 to 21.
  • Loneliness – measured with both the Three-item loneliness scale (3IL), covering loneliness in the last two weeks and a daily diary asking “How lonely do you feel today?”, with scores ranging from 1 to 7.

After filling out baseline questionnaires, 214 individuals were equally split into the two arms of the study. Their demographics were evenly split between the arms: mean age was 60, 89% were male, 69% White and 74% gay.

Individuals in the intervention group were given 25 days to listen to fourteen mindfulness lessons. They could listen to the pre-recorded audio lessons whenever they liked, from any internet-connected device, including a mobile app. Most of them reported that the lessons were user-friendly.


After the 25 days, participants completed the same questionnaires as at baseline. 93% (99) participants completed their follow-up in the intervention arm. 96% (103) did in the control arm.

Participants were very compliant with listening to lessons. 85% completed all fourteen lessons. 92% completed at least ten of them, a number considered a “sufficient dose” by the investigators.

After 25 days, depression levels measured among all participants improved by 2.6 points (p<0.01) in the intervention arm, compared to the non-intervention one. This translates into a 20% difference between the two arms. Looking specifically at participants with depression at baseline, the intervention effect was even more pronounced: depression improved by 4.2 points (p<0.01) and the difference between the two arms was 26%.

For all participants, levels of anxiety decreased by 1.5 points (p<0.03) in the mindfulness arm (22% difference between arms). For those anxious at baseline, they decreased by 2.4 points (p<0.001), leading to a 26% difference between arms.



A mental health problem causing long-lasting low mood that interferes with everyday life.


A feeling of unease, such as worry or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in particular situations.

chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include difficulty breathing, cough, mucus (sputum) production and wheezing. It is caused by long-term exposure to irritating gases or particulate matter, most often from tobacco smoking (active or passive).

opportunistic infection (OI)

An infection that occurs more frequently or is more severe in people with weakened immune systems, such as people with low CD4 counts, than in people with healthy immune systems. Opportunistic infections common in people with advanced HIV disease include Pneumocystis jiroveci pneumonia; Kaposi sarcoma; cryptosporidiosis; histoplasmosis; other parasitic, viral, and fungal infections; and some types of cancer. 

Results for loneliness were mixed. For loneliness in the previous two weeks, no significant change was observed between the two study arms. However, loneliness recorded in daily diaries significantly reduced. For example, participants with at least moderate loneliness at baseline saw their loneliness levels decrease by 0.7 (p<0.001), translating into a 19% improvement.

Based on these promising results, the investigators proceeded with supplementary analyses of key subgroups. In each one, depression, anxiety and loneliness improved significantly or were close to doing so.  The three subgroups were:

  • Hispanic people, Black people and females (grouped together).
  • People with obesity, diabetes or chronic obstructive pulmonary disease (COPD), which are conditions known to expose individuals to severe COVID-19 complications.
  • People with an annual income below $50,000, which might severely limit access to mental health care.

Berko concluded that online mindfulness audio lessons may offer emotional relief to many older people living with HIV who suffer from depression, anxiety and loneliness.


Berko J et al. RCT of an online mental health intervention among older PLWH during COVID-19 epidemic. Conference on Retroviruses and Opportunistic Infections, abstract 110, 2021.

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