Mental health support essential for HIV patients facing suicide risk, UCT study finds

In a revealing new study conducted by researchers from the University of Cape Town (UCT) in collaboration with Linköping University, Sweden, alarming insights have emerged regarding the heightened risk of suicide faced by individuals living with HIV. The study underscores that a concoction of stigma, fear of disclosure, mental health challenges, and gaps in primary healthcare services significantly elevate the suicide risk in this vulnerable population. The findings call for immediate integration of mental health support into routine HIV care to mitigate this grave issue.

Published in the AIDS Care journal, the research delves into healthcare workers' perspectives on the risk factors and barriers to care, as well as the prevention needs in primary healthcare settings. The research team engaged in insightful interviews with 13 healthcare workers from three primary healthcare clinics in Khayelitsha.

Associate Professor Stephan Rabie, the study’s principal investigator and chief research officer in UCT’s Department of Psychiatry and Mental Health, stressed the complexity of the issue: “Suicide disproportionately affects people living with HIV. The reasons for this elevated risk are complex and multifaceted. There isn’t one specific causal pathway that can explain why people with HIV are particularly vulnerable to die by suicide. Rather, people with HIV are confronted by a combination of situational stressors that compromise their mental health and increase their risk for suicide.”

Rabie elaborated on the far-reaching implications of these findings, noting that the elevated risk of mental illness and related suicide outcomes adversely affects the entire HIV care continuum. “This includes delays in treatment initiation, poor HIV care engagement, and reduced life expectancy,” he added.

Historical data indicates that individuals who ultimately take their own lives often had interactions with healthcare settings within the year leading to their deaths. In South Africa—where the majority of people with HIV receive care within public sector facilities—the opportunity to screen for and prevent suicide among those seeking HIV care remains vastly underutilised.

Highlighting the urgent need for intervention, Rabie stated, “Our findings showed that among people with HIV, suicidal ideation and behaviour are driven by a confluence of stressors such as experiencing rejection after disclosing HIV status, and general social stressors, like unemployment and financial deprivation.”

In stark contrast to high-income countries where psychiatric disorders are a predominant driver of suicide, low-resource settings like South Africa see socio-economic challenges playing a more significant role. Rabie pointed out that these findings were echoed throughout the study. One participant noted, “Because sometimes you will find out it is not HIV [that is] the problem. There is something else other than HIV, the poverty at home, the lack of education, and now it is this burden of medication, or there is family violence at home.”

Among the study’s key revelations, researchers identified a significant barrier to suicide prevention—namely, the lack of routine suicide screening and insufficient training in suicide risk assessment among primary care workers. “Providing opportunities for training in suicide risk assessment that are accessible and not burdensome to healthcare workers will be an important first step in addressing the syndemic of suicide in South Africa,” Rabie asserted.

The study advocates for two crucial strategies to enhance suicide prevention among those living with HIV. Firstly, it emphasises the integration of mental healthcare into HIV clinical settings. As Rabie noted, considering the coexistence of psychiatric disorders, suicidal behaviour, and HIV, embedding mental healthcare into routine HIV care could be instrumental in identifying individuals needing further support.

Secondly, Rabie pointed to the necessity of brief interventions aimed at equipping primary healthcare workers to address the multifaceted factors influencing suicide among people living with HIV. Such interventions could include counselling programmes centred on psycho-education regarding suicide risk factors.

“The findings from this study will inform the development of a brief intervention that introduces brief safety planning to reduce suicide risk and training in adaptive coping skills to manage the stress that drives suicidal ideation and behaviour. In partnership with the City of Cape Town and Western Cape Department of Health and Wellness, this intervention will be pilot tested in primary healthcare facilities across the Cape Metro in 2026,” Rabie said.

This pivotal study has found support from both the Fogarty International Centre and the National Institutes of Mental Health in the USA.

Weekend Argus