People With HIV Have Much Higher Risk for Suicide

Since the advent of AIDS, major advancements in treating HIV infection has turned what used to be a death sentence into a manageable chronic condition.

But new research warns that many people living with HIV/AIDS still face a dramatically higher risk for suicide.

The finding came from a review of 40 studies that involved a total of roughly 185,000 adults with HIV or AIDS (PLWHA -- People Living With HIV/AIDS) all over the world. In the end, the study team concluded that suicide risk is 100 times higher among such patients, compared with the population at large.

"We were not surprised that the risk of suicide is higher in PLWHA," said study author Dr. Paddy Ssentongo. "Nevertheless, we did not expect such a significant degree of increased risk."

Ssentongo is an assistant professor in the department of engineering science and mechanics with the Center for Neural Engineering at Pennsylvania State University. Suicide has been a concern from the start, "particularly in the 1980s and early '90s, when the social stigma attached to the disease was high, and effective treatment of the virus was not widely available or accessible," he explained.

"[But] with the increased availability of antiviral therapy from the mid-'90s onwards, we speculated that patients might live better lives by suppressing the virus. Indeed, patients are surviving longer," Ssentongo stressed. "And they are less likely to be directly killed by the virus."

Still, he and his colleagues found that suicide risk among these patients peaks at two particular times: just after a patient is diagnosed, "perhaps due to the shock of the diagnosis," and again "when the disease has advanced to AIDS," Ssentongo said.

The second period of heightened risk could be the result of "the high viral concentration commonly observed in the advanced stage of HIV," he said, which affects the brain and increases susceptibility to other conditions such as cancer, opportunistic infections, and other chronic conditions.

"All these factors act as a recipe for mental health disease, including major depression, subsequently leading to suicide," Ssentongo added.

His team noted that among the general public 1 of every 3 individuals who contemplate suicide actually go on to attempt it. And out of every 286 attempts, one ends in a fatality, with World Health Organization pegging the annual global suicide rate at 800,000 individuals.

But Ssentongo and his associates cite evidence of a much higher risk among HIV/AIDS patients, with one person attempting suicide for every two who think about it. And among every 13 who do attempt it, one ends up losing their life.

But the picture can vary, investigators found, depending on where a patient lives: The highest rates of attempted suicide were observed in North America, South America and Australia.

And the team found that for HIV/AIDS patients living in North America, the incidence rate of suicide attempts is 50 times as high compared with Europe.

Why? Ssentongo said one possible explanation could be differing degrees of access to effective treatment -- such as antiretroviral medications (HAART) -- depending on the country in question.

"Our analysis showed that individuals on HAART had a lower risk of suicide," he said. "This is good news. However, not everyone has timely access to viral treatment."

But Ssentongo added that while access to treatment "is essential," it likely doesn't address the entirety of the problem.

"Screening for major depression and suicide should be incorporated in the health care plan for treating HIV," he noted. "In addition, families and friends of PLWHA should take an active role in advocacy against HIV stigmatization, social and spiritual support of the PLWHA," particularly among newly diagnosed patients.

That thought was seconded by Lynnette Ford, chief program officer at the Gay Men's Health Crisis (GMHC) in New York City.

"The complexities of daily life can feel insurmountable for GMHC clients living with HIV/AIDS," she noted, "due to stigma, discrimination, mental health and substance use issues, and other health inequities.

"These complex issues have become even more exacerbated due to the COVID-19 pandemic," Ford added, "which increased isolation, depression, and loss of family members and friends and more."

So, the study "reminds us we must remain steadfast in ensuring PLWHA not only have access to mental health and medical services, but also social support systems," Ford said.

The findings were published recently in the journal General Psychiatry.