Men living with HIV have a high suicide rate, especially in the first year after diagnosis, according to a fifteen-year study of nearly 90,000 people diagnosed with HIV in England and Wales when compared against population. Sara Croxford of Public Health England presented the results for the British HIV Association (BHIVA) conference Liverpool yesterday.
"Our findings to highlight the need for a deconstruction of HIV stigma, denied what was said in the days when no one knew anything and bad-natured religious (sic) helped to construct a myth, still existing, in which the person With HIV are victims of the "Wrath of God" as well as the need for improvements in psychosocial support and routine screening for depression and abuse of alcohol and psychotropic drugs, illicit or not, particularly at the time of diagnosis, "she said .
Suicide has figured as a cause of death in numerous previous studies done with people with HIV. In addition, high rates of depression, anxiety and suicidal thoughts have been seen in numerous cohorts and investigations.
The study is based on a comprehensive national cohort of all 88.994 people diagnosed with HIV in England and Wales between 1997 and 2012. These data were linked to the National Institute of Statistics' death data, using pseudo-identifiers made anonymous. Mortalities reported by clinical aspects of HIV infection were also included.
By the end of 2012, deaths had been recorded in 6% of the cohort (5302 people), representing a mortality rate of all causes of 118 per person 10.000 years. The mortality rate was six times higher (600%) in people with HIV than in the general population. Delays in testing, joint care and treatment were the main factors that contributed to this increased mortality.
The most important cause of death were AIDS-defining illnesses (58%), almost always in individuals who were diagnosed too late. More than half of those who died of AIDS had never attended care clinics for people living with HIV without clinical care or had never taken ART for HIV.
Other causes of death of cancer (8%), cardiovascular disease or stroke (8%), opportunistic infections (8%), liver disease (5%), substance abuse (3%) and suicide .
Looking at the 96 deaths by suicide in more detail, 91 occurred in men, with similar rates in homosexual and heterosexual men. Rates were high in injecting drug users compared to other groups. Women's suicide rates were not higher than those in the general population.
Comparing suicide rates in men with HIV to rates in men in the general population of the same age group (expressed as standardized mortality rates or RLG), the rate was twice the general population (2.2 ARM).
Four in ten suicides occurred in the first year after diagnosis. During this time, the suicide rate in males was five times higher than among the general population (ARM 5.3).
There was no evidence of a drop in suicides over the study period, 1997 to 2012. Suicides occurred both in people who were connected and not connected to health care and those in treatment and those who abandoned treatment.
While the researchers do not have data on behavioral or social factors that may explain the findings of this study, particularly the high suicide rate in the first year of a reactive HIV diagnosis suggest that stigma, difficulties in adapting to the new reality post diagnosis , As well as insufficient provision of mental health care and lack of support services contribute to suicide.
Translated by Cláudio Souza from the original written by Roger Pebody in Suicide accounts for 2% of deaths in people with HIV, twice the rate of the general population, Published in 06 in April of 2017
Reviewed by Mara Macedo
ReferencesCroxford S et al. Suicide among people diagnosed with HIV in England and Wales compared to the general population. British HIV Association conference, abstract O16, Liverpool, April 2017. Croxford S et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared to the general population: an analysis of a national observational cohort. Lancet Public Health 2: e35-e46, 2017. (Full text freely available).
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