Association between self-reported HIV status and suicidal behavior among adult injection drug users in the San Juan metropolitan area, Puerto Rico

Few studies have explored HIV+ status and suicidal behavior among drug users. In PR, intravenous drug use (IDU) is the main risk factor in HIV transmission, making HIV+ IDUs the most important group to study. The purpose of this study was to determine if self-reported HIV status among IDUs was associated with suicidal behavior (ideation and attempts). In this cross-sectional study, 400 IDUs not in treatment from the San Juan metropolitan area were recruited from copping areas and shooting galleries using ethnographic mapping strategies. Multiple logistic regression models were used to evaluate the association between each suicidal behavior with self-reported HIV status and socio-demographic, health-related, and substance use variables. No multicollinearity or interactions were found. Most IDUs were males, not high school graduates, not employed, and had been incarcerated. Mean age was 32.8±9.1 years; mean time of injecting drugs was 11.6±10.2 yrs. Prevalences of suicidal ideation (31%), attempts (23%) and depression (83%) were higher than in the general population. Self-reported HIV+ status was not associated with suicide attempts, but being HIV(-) was associated with ideation. The strongest risk factors for attempts were cocaine use and depression; for ideation, cocaine use and recent health care due to mental problem. Other significant risk factors for suicidal behavior included: being female, living alone, having ≥8 lifetime sexual partners, not using speedball, and lifetime use of crack, sedatives/tranquilizers, and other opiates. Suicidal behavior is an important problem among IDUs that needs to be addressed.