Background: Depressive symptoms are common among HIV-positive men who have sex with men (MSM). This study aims to explore (1) the relationship between family functioning and depressive symptoms and (2) the mediating roles of stigma and resilience in the relationship among HIV-positive MSM.
Methods: We used data from a cross-sectional study of a convenience sample in Hunan Province, China, conducted in 2019. The data analysis included 191 HIV-positive MSM with an average age of 26.98 years. All participants completed self-report questionnaires on demographic variables, family functioning, stigma, resilience, and depressive symptoms.
Results: Better family functioning was significantly associated with lower depressive symptoms. Both stigma (Indirect effect = − 0.04, 95% CI, − 0.10 ~ − 0.001) and resilience (Indirect effect = − 0.06, 95% CI, − 0.12 ~ − 0.01) were significant partial mediators in the relationship between family functioning and depressive symptoms. A parallel and chain mediating role of stigma and resilience in the relationship between family functioning and depressive symptoms was also supported (Indirect effect = − 0.03, 95% CI, − 0.08 ~ − 0.01).
Conclusion: Improving family functioning is crucial for alleviating depressive symptoms among HIV-positive MSM in China. Depression assessment and reduction should be an integral part of prevention and treatment programs targeting stigma and resilience.

Keywords: HIV, men who have sex with men, family functioning, stigma, resilience, depressive symptoms