Does suicidality continue to occur among individuals with HIV engaged in care in the era of antiretroviral therapy?

Background: Understanding barriers to HIV medication adherence is imperative in order to identify methods to reduce transmission risk and improve health outcomes. Psychological distress has been identified as a barrier to consistent care and medication adherence.  This study was conducted to specifically assess factors related to suicidal ideation among a sample of individuals seeking HIV care at a Midwestern US urban clinic.

Methods: Clinic patients completed a psychological and behavioral annual assessment during routine visits. Suicidal ideation was measured within the past 2 weeks using the PHQ-9. Anxiety symptoms were measured using the GAD-7. Medical markers were abstracted from medical records.

Results: A total of 628 participants were included in this study; 79 reported suicidal ideation in the previous 2 weeks. This occurred more often among individuals with unsuppressed viral loads, who endorsed moderate-severe anxiety symptoms, among women, those who considered themselves homeless, and who were unemployed (p <0.05 for all). Lastly, individuals reporting no sex partners in the previous 3 months were more likely to endorse suicidal ideation. There were no significant differences in average alcohol use, or CD4 cell count. Homeless individuals had 5.6 odds and those endorsing significant anxiety had 1.9 odds of reporting suicidality.

Conclusions: Even among populations with access to HIV care and medications, HIV infection seems to persist as a disease that is associated with socioeconomic challenges, psychological well-being, and gender. These findings heighten the need to address systemic problems by developing and testing multilevel interventions to address inequities in care experiences.