Intersecting Burdens: Pain and Psychosocial Stressors in Women with HIV and Type 2 Diabetes – Insights from the MACS/WIHS Combined Cohort Study

Introduction HIV has transitioned into a chronic condition often accompanied by multimorbidity, including type 2 diabetes (T2D). Women with HIV (WWH) and T2D face elevated risks for depression, loneliness, and reduced social support. Pain—a common and burdensome symptom in both conditions—remains underexamined despite its potential to exacerbate psychosocial challenges and diminish quality of life. Methods We conducted a cross-sectional analysis using data from the MACS/WIHS Combined Cohort Study (MWCCS), focusing on the Women’s Interagency HIV Study (WIHS) subset. Self-reported measures included pain status (dichotomized as yes/no) and mental health outcomes (depressive symptoms, loneliness, social support, and quality of life). Clinical variables included HIV serostatus, diabetes status, hemoglobin A1c, and body mass index. Generalized linear regression models assessed associations between pain and mental health outcomes, adjusting for demographic and clinical covariates. Results Among 2,410 participants, 72% identified as Non-Hispanic Black, 10% as Non-Hispanic White, 15% as Hispanic, and 4% as other; mean age was 47.4 years (SD = 9.3) and BMI 31.8 (SD 8.9). Seventy-one percent were HIV seropositive, 19% had diabetes, and 67% reported pain. Overall, participants reported moderate social support (mean = 57.1, range 15–75), with higher scores among women with diabetes (mean = 66.3) compared to those without diabetes (mean = 57.3). HIV status did not significantly influence social support. Fully adjusted models revealed strong associations between pain and all mental health outcomes (p < 0.001). Women reporting pain had higher depressive symptoms (B = 7.59; 95% CI: 6.68, 8.49), greater loneliness (B = 0.80; 95% CI: 0.65, 0.94), lower social support (B = − 5.37; 95% CI: −6.64, − 4.10), and markedly lower quality of life (B = − 23.44; 95% CI: −24.87, − 22.01) compared to women without pain. No significant interactions were observed by HIV or diabetes status. Conclusions Pain is strongly associated with worse psychosocial outcomes among women in WIHS, regardless of HIV or diabetes status. These findings highlight the need for integrated, patient-centered interventions that address pain alongside mental health and social support to improve quality of life for women with multimorbidity. Future research should explore longitudinal patterns and tailored strategies to mitigate the compounded burden of pain and psychosocial distress.