Suicide is estimated to claim one life every eleven minutes in the U.S., according to the CDC. Unfortunately, the risk of death by suicide increases by about 100 times for people living with HIV/AIDS (PLWHA). These devastating statistics demonstrate the need for increased mental health support for PLWHA. Especially given high rates of suicidality among PLWHA in North America, this public health crisis deserves swift action.
Understanding the Research
This systematic review and meta-analysis analyzed records from over 185,000 adults living with HIV/AIDS across the globe, to assess the risk factors and incidence of their attempted and completed suicides. This research found that the risk of suicide completion increased as adult participants progressed from HIV to AIDS, while antiretroviral treatment and higher CD4 counts are protective factors against suicide attempts. In terms of limitations, there may be differences in the way in which suicide was reported, and the overall methodology of studies, as this research reviewed a total of 40 full-text articles in this meta-analysis.
Fears of Rejection Increase Risks
Psychiatrist Howard Pratt, DO, behavioral health medical director at Community Health of South Florida says, “Decades ago, HIV and AIDS was a death sentence. But today, people across the economic spectrum are living healthier normal lives.” In comparison to receiving other diagnoses of a chronic condition, Pratt highlights the stigma still attached to HIV and AIDS. “This stigma is what will cause people not to get help. Their fear is often driven by negative associations about sexuality, substance abuse, lower social-economic status, and the threat friends and family will reject them,” says Pratt. Pratt says, “When someone who is diagnosed with this disease hears the whisper of a relative telling another relative not to touch them, this sort of ignorance has real consequences, and that stigma is what pushes people to hide and suffer. We need to continue the education of society as a whole about HIV and AIDS. The more we do this in the same way we educate society about heart disease or diabetes, the better things are going to be.”
Stigma Contributes to Suicidality Risk
“Compared to chronic conditions such as obstructive lung disease, hypertension, and diabetes, as well as causes of prolonged illness and death such as dementia, autoimmune diseases, and cancer,” says Renato (Rainier) M. Liboro, PhD, assistant professor of psychology at the University of Nevada, Las Vegas. “HIV/AIDS continues to be inextricably associated with more comorbidities such as hepatitis and other sexually transmitted infections, neurocognitive disorders, cardiovascular disease, and various mental health issues, all of which place PLWHA at higher risk of suicidality.” In addition to the comorbid conditions that PLWHA have to deal with that increase their risks for suicidality, Liboro highlights how PLWHA have also historically faced syndemic factors that have been found to interact with HIV/AIDS, such as problematic substance use, sexual compulsivity, partner violence, homelessness, and depression. Liboro explains that many PLWHA are sexual and gender minorities, racial and ethnic minorities, injection drug users, and sex workers, who have had the increased burden of having to deal with the ubiquity and perniciousness of HIV/AIDS stigma since the start of the epidemic, which remains a consistent driver of suicidality.
Social Support is Vital
Liboro shared how advocacy and activism have been led and championed by PLWHA themselves, especially by those from communities that are BIPOC, LGBTQIA+, etc. “This advocacy and activism have opened doors for the advancement of the treatment and medical management of HIV/AIDS, increased awareness of the larger society on the science and facts about HIV/AIDS, the improvement of healthcare and social services for PLWHA, their access to these essential services, the recognition and safeguarding of the human rights of PLWHA against prejudice and discrimination, and the fight against the criminalization of HIV/AIDS,” he says. While AIDS service organizations have made strides, Liboro reiterates that there is still more that needs to be done to improve equitable access for all PLWHA. Liboro agrees with the recommendation to prioritize suicide risk assessments among PLWHA. He says, “Everyone has a role to play in doing a better job at supporting PLWHA—clinicians, service providers, key opinion leaders, policymakers, advocates, allies, and academic researchers. Stakeholders should uphold the commitment to the Denver Principles (1983) of Greater and Meaningful Involvement of People living with HIV/AIDS (GIPA/MIPA), and equitably involve PLWHA in that work.” If you or someone you love has HIV and is struggling with their mental health, don’t hesitate to reach out for professional support. National Suicide Prevention Lifeline: 1-800-273-8255 (TALK) The National Domestic Violence Hotline: 1-800-799-SAFE (7233) The National Sexual Assault Hotline: 1-800-656-HOPE (4673) The Trans Lifeline: 1-877-565-8860 The Trevor Project Hotline: 1-866-488-7386
