South Africa: Suicidality among HIV+ young women

The Southern African region has the world's highest HIV infection rate in women 15-24 years old. Suicidal behaviour is common and two studies look into this.

Suicidal behaviour among young women living with HIV

Young women living in Southern Africa with HIV who are aware of their infection status were studied. The following key questions were addressed:

1. What are the effects of poor HIV care and HIV-related stigma on suicidality?
2. How do mental health problems such as anxiety disorders, post-traumatic stress disorder and depression influence the relationship between poor HIV care, stigma and suicidality?
3. To what extent can social support break the direct and indirect link between poor care and stigma on suicidality?

The first step was to investigate how poor HIV care and HIV-related stigma affect suicidality. Factors such as age, living in rural areas, poor housing conditions and poverty were taken into account.

In the second step, the study analysed the impact of mental illness in the absence of HIV care and stigma on increasing suicidality rates.

In the third step, social support was examined as an influencing factor in both HIV care (retention) and stigmatisation, as well as the influence of social support in mental illness on the development of suicidality rates.

Mzantsi Wakho: Results and evaluation

The average age of women infected with HIV was 18 years. 23% lived in rural areas, 20% had no fixed abode. 76% of the study participants did not have access to all basic daily necessities, such as warm clothes, warm shoes and enough food for at least three meals a day. 55% had recently contracted HIV.

7% of the women included in the study had suicidal thoughts or had already attempted suicide. 33% had not remained in care during the previous year, had missed appointments at clinics and had not complied with antiretroviral therapy. 31% of the women suffered from at least one form of stigma related to their HIV infection. 33% showed signs of mental illness such as anxiety disorders, depressive or post-traumatic symptoms. 85% of the women reported receiving social support, either material or emotional. Such support could be accompaniment to medical appointments or help with meal preparation, as well as counselling for emotional and personal problems.

The results of the studies show that HIV+ young women with poor HIV care and HIV-related stigma are at greater risk of becoming suicidal. Mental illness and problems are causally linked to this.

Poor HIV care is associated with lower rates of mental illness and higher rates of suicidality; stigma leads to higher rates of mental illness and higher suicidality.

Social support cushions the direct and indirect consequences of poor HIV care and stigma on mental health, and can also lead to a reduction in suicidality when mental illness is already present.

Summary:

• Poor HIV care and stigma increase suicide risk for young women with HIV infection.
• Mental illness and problems resulting from poor care and stigma increase suicide risk.
• Social support can mitigate the effects of poor care and stigma and reduce suicide risk.

Conclusions:

• Suicide prevention and its continuation must be components of HIV care.
• Young women with HIV infection should be screened for suicide risk by paying attention to their mental health, the impact of stigma and psychosocial support. Especially those who do not remain in HIV care and have poor social networks.
• Peer support groups contribute to the strengthening or emergence of social relationships and strengthen mental health. This can contribute to reducing the risk of suicide among young women living with HIV.

This article is based on the presentation "Social support attenuates the syndemic of poor HIV care and stigma on suicidal tendencies among South African young women living with HIV" by Wylene Saal at this year's AIDS conference. esanum covered the 24th International AIDS Conference in Montreal, Canada, from 29 July to 2 August 2022. For more articles, please visit our dedicated AIDS 2022 congress page