Introduction

People with HIV infection, like others with serious diseases, may have thoughts about suicide. They may also engage in self-harming behaviors that have a significant suicide risk. These thoughts and actions may not be just a measure of distress or desperation, but may strongly suggest the presence of a severe depressive disorder that could benefit from specialist mental health intervention.

From the beginning of the epidemic and well into the 1990s, suicidal behavior in people with HIV infection was the subject of a good deal of research. Results indicated that people with HIV have a greater risk of suicide, deliberate self-harm and suicidal ideas than those without the infection, and clinical experience generally confirmed these findings. Since the introduction of highly active antiretroviral treatments in the mid 1990s, those involved in the care of people with HIV have noted a decline in the incidence of suicide, and few reports have appeared in the literature on the topic. It could be argued that the improvements in HIV-related mortality and morbidity resulting from the widespread use of combination therapy has contributed to a greater sense of hope for people with HIV and this, in turn, has led to positive changes in suicidal behavior.

Care providers should be able to assess suicidal ideas, recognize the presence of suicide risk and its degree, and formulate an intervention plan.