Background <p>Depressive symptoms are common among people living with HIV (PLWH) and may adversely affect sexual function. However, the relationship between HIV infection and premature ejaculation (PE) has not been clearly defined. This study aimed to evaluate depressive symptoms in HIV-infected men and investigate their association with PE.</p> Methods <p>This multicenter case–control study included 112 HIV-infected men and 110 age-matched healthy controls who presented to infectious diseases outpatient clinics between March and September 2025. All participants completed the Turkish validated versions of the Premature Ejaculation Diagnostic Tool (PEDT) and the Beck Depression Inventory (BDI). PE was defined as a PEDT score ≥ 11.</p> Results <p>The mean age of PLWH was 36.3 ± 11.9 years, compared with 39.6 ± 10.8 years in the control group. Both PEDT and BDI scores were significantly higher in PLWH than in controls (<i>p</i> &lt; 0.001 for both). PE was present in 49 (43.8%) HIV-infected men and 23 (20.9%) controls (<i>p</i> &lt; 0.001). Among PLWH, those with PE had significantly higher BDI scores than those without PE (16.8 ± 10.1 vs. 10.7 ± 8.9, <i>p</i> = 0.009). In multivariable logistic regression analysis, BDI score remained independently associated with PE after adjustment for erectile function, age, and disease duration.</p> Conclusions <p>HIV-infected men demonstrated higher rates of PE and more severe depressive symptoms compared with healthy controls. Among PLWH, depressive symptom severity remained significantly associated with PE after adjustment for erectile function, age, and disease duration.</p> Graphical Abstract <p></p>