HIV, Depression, and Suicide

By: Ranier Simons, ADAP Blog Guest Contributor

In the early years of the HIV epidemic, a diagnosis was effectively a death sentence. There were no robust treatment regimens, and life expectancy was low. People suffered a great deal being overcome by opportunistic infections and lived in a great deal of isolation, whether in a hospital setting or at home. This resulted in a high prevalence of depression. Over the past few decades, medical advances in HIV treatment have transformed an HIV diagnosis into a manageable chronic health issue with people living long, healthy lives on antiretroviral therapy. But has mental health advances kept pace?

Photo Source: HIV.gov

Despite the advances, a high rate of depression and suicide remains among people living with HIV (PLWHA). Depression in PLWHA results in worsened disease states and poorer health outcomes. Data shows that depression can hasten the progression of AIDS, resulting in higher viral loads and lower CD4 counts.[1] Many PLWHA also have mental comorbidities that exacerbate their risk of suicide.[2] A recent study being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark (15–18 April), further examines depression and suicide in PLWHA.

The observational study utilized data from Denmark’s national health registers from 1995 -2021. The study compared 5,943 PLWHA with 59,430 sex and date-of-birth-matched controls from the general population. Researchers also investigated 5,807 siblings of PLWHA and 82,411 siblings of controls.[3,4] Overall, PLWHA had twice the risk of depression and treatment with electroconvulsive therapy, 1.5 times the risk of using antidepressants, and 3.5 times the risk for suicide.[3,4] These numbers were higher for the first two years after diagnosis. During this period, PLWHA had a threefold higher risk of depression and antidepressant use and a tenfold risk of suicide.[3,4] The study data also showed an increased risk of depression and suicide for the siblings of PLWHA compared to the general population, but it was not as high as the risk for PLWHA.

Photo Source: AIDSmap

This study was specific to Denmark. Other studies in the past, encompassing a global perspective, indicate that globally PLWHA have a 100 times higher risk of suicide than the general population.[5] Researchers agree that many more studies need to be conducted. The main weakness in the data from present and past studies is the variance. These observational studies try to normalize the data by comparing subjects to general population controls. However, past studies contain many differences in subject selection criteria. There are differences in cultural norms of the subjects, variance in types and availability of antiretroviral therapies or lack of them, and even societal factors that vary between continents.

What does not vary is the urgency of the need to address the mental health of PLWHA. Medical science has a focused, concerted effort to develop medications to treat and prevent. The same energy is needed to address psychological needs. Mental health screening of PLWHA must go hand in hand with treatment. PLWHA often have poor social support, face stigma, and don’t have access to trained mental health professionals.[2] Additional research also needs to thoroughly investigate issues such as long-term antiretroviral treatment's biological and cognitive effects or identifying pre-HIV infection mental comorbidities that may cause a higher incidence of depression and suicide once infected. 

Going forward, the mental health assessment and support of PLWHA must be on a continuum. It should start with psychological counseling and support when someone is about to be tested all the way through positive diagnosis, treatment, and long-term survival. Standardizing evidence-based mental health protocols for PLWHA will prevent suicides and improve the lives of PLWHA and their families and friends.

[1] Tran, B. X., Ho, R. C. M., Ho, C. S. H., Latkin, C. A., Phan, H. T., Ha, G. H., Vu, G. T., Ying, J., & Zhang, M. W. B. (2019). Depression among Patients with HIV/AIDS: Research Development and Effective Interventions (GAPRESEARCH). International journal of environmental research and public health, 16(10), 1772. https://doi.org/10.3390/ijerph16101772

[2] Liu, Y., Songtaweesin, W., Tucker, J., Sohn, A., Latkin, C., Hall, B. (2022). Suicide prevention research is crucial to achieving health equity for people with HIV. The Lancet HIV, 9(11),E745-E746, https://doi.org/10.1016/S2352-3018(22)00296-X

[3] American Association for the Advancement of Science. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide, especially in first 2 years after diagnosis. Retrieved from https://www.eurekalert.org/news-releases/984677#.ZC75j2xKVyk.twitter

4) Medical Express. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide. Retrieved from https://medicalxpress.com/news/2023-04-people-hiv-substantially-higher-depression.html

5) Pelton, M., Ciarletta, M., Wisnousky, H., et al. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. General Psychiatry 2021;34:e100247. doi: 10.1136/gpsych-2020-100247

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Hope for Now: Addressing Suicide Among PLWHAs

By: Jonathan J. Pena, MSW, Licensed Clinical Social Work Associate (LCSWA)

“This highway's dark and empty.

Just miles and miles of endless road.

I've got a sickness pounding in my head.

I'm at the mercy of the ghost.”[1]

A diagnosis of being HIV positive back when this epidemic began, was synonymous with death. This, now dark road, was paved with unfathomable fear as more questions arose than answers. The virus was no longer the only infection that had occurred, as despair took form and occupied more mental space than hope. While receiving a diagnosis of being HIV positive no longer is a death sentence thanks to antiretroviral medication, people living with HIV/AIDS can sadly still face this type of mental darkness as a part of their lived experiences that leads to suicide ideation and successful suicide attempts.

Photo Source: Getty Images / tadamichi

Annually, an estimated 800,000 people die worldwide from suicide according to the World Health Organization.[2] In looking at the general population who have suicidal ideation, 1 out of 3 will attempt to commit suicide and one death will result from 286 attempts.[3] When compared to the general population, one in every two people living with HIV/AIDS experiences suicidal ideation and one attempt at suicide will occur according to a study conducted by the Penn State University College of Medicine.[4] Additionally, data analysis from 185,000 people living with HIV/AIDS indicated that this population were 100 times more likely to die from attempted suicide in contrast to the general population.[5] 

“I sought after, after reasons to stay

I was lost, I was lost”[6]

People living with HIV/AIDS experience risk factors that can contribute to the strong sentiments of feeling lost within their diagnosis. One of the most profound sources that impacts healthy experiences of happiness is the connectivity we received from other people. People serve as the bridge and catalyst of shared experiences across time and locations. Societal stigma towards HIV/AIDS works to sever these dynamic and powerful human connectivity by devaluing basic human respect and compassion. Society often labels people living with HIV/AIDS as other within communities and this population quickly become outcasts. Through this process, shame and guilt can be fostered and become increasingly hard to overcome if we are not effectively targeting and addressing mental illness within this population. Dr. Paddy Ssentongo, a researcher and epidemiology doctoral student stated that “there is an urgent need to prioritize mental health screening and care into all HIV testing and treatment settings.”[7] As a social worker within mental health, I really resonate with this statement. Targeting HIV testing and treatment settings can help clinicians to target people who may be suffering with trying to find reasons to stay in this world because the darkness they feel from society as a result of their diagnosis. Additionally, this population faces other risk factors like neurological changes, poverty, lack of access to care and advanced disease.[8] 

“How can I instill such hope, but be left with none of my own?

What if I could sing just one song and it might save somebody’s life?”[9]

When we shift our perspective of HIV/AIDS from an individual issue to community healing, we usher in hope that may have been lost with a positive diagnosis. We need to strengthen and revitalize our approach to HIV/AIDS treatment and prevention to include mental health screening. Effective patient centered care isn’t solely about the diagnosis and approaching it as such would greatly diminish our ability to make effective, long lasting changes when it comes to treatment as a whole. We need to incorporate more of the human component to HIV treatment and care because it is within that sphere that we get to learn about the lived experiences that are occurring. Again, remember that people are LIVING with HIV/AIDS, so we need to understand how the various aspects of their lives intersect with one another. This provides invaluable information that can useful in targeting mental health screening across areas like healthcare, poverty, childcare, employment, and education, just to name a few. 

Living with HIV/AIDS doesn’t need to become a dark and empty pathway that extinguishes the hope of a continued happy and fulfilled life. Modern medicine has changed the landscape of HIV treatment and care opening up the road of this population to live long and healthy lives. Now, in order to strengthen this approach to longevity, we need to remember our own humanity and incorporate that element of strength in order to give hope to those of us sitting in the dark.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

[1] Song Lyrics by City of Colour, “Hope for Now”.

[2] Cox, T. (2021). People living with HIV/AIDS have a significantly higher risk of suicide. Penn State News. Retrieved from: https://news.psu.edu/story/661753/2021/06/28/research/people-living-hivaids-have-significantly-higher-risk-suicide#.YOhQh_nmJ0Z.twitter.

[3] Cox. People living with HIV/AIDS have a significantly higher risk of suicide.

[4] Cox. People living with HIV/AIDS have a significantly higher risk of suicide.

[5] Cox. People living with HIV/AIDS have a significantly higher risk of suicide.

[6] City of Colour. Hope for Now.

[7] Cox. People living with HIV/AIDS have a significantly higher risk of suicide.

[8] Cox. People living with HIV/AIDS have a significantly higher risk of suicide.

[9] City of Colour. Hope for Now.