A collaborative study by researchers at the University of Cape Town (UCT) and Linköping University in Sweden has found that people with HIV face a heightened risk of suicide, underscoring the urgent need to integrate mental health services into routine HIV care, according to the researchers.
The study highlights how stigma, fear of disclosure, mental health challenges and gaps in primary healthcare services combine to increase vulnerability among people living with HIV, they said.
Published in the Aids Care Journal, the study explored healthcare workers’ perspectives on suicide risk factors, and barriers to care and prevention needs within primary healthcare settings, reports the Cape Argus.
For their study, the teams conducted in-depth interviews with 13 healthcare workers from three primary health clinics in Khayelitsha.
Associate Professor Stephan Rabie, a chief research officer in UCT’s Department of Psychiatry and Mental Health and the study’s principal investigator, said suicide disproportionately affects HIV+ people, due to a complex interplay of factors.
He said there isn’t one specific causal pathway to explain why they were particularly vulnerable to suicide.
“Rather, they are confronted by a combination of situational stressors that compromise their mental health and increase their risk.”
The elevated risk of mental illness and suicide has serious implications across the HIV care continuum, he added, including delayed treatment initiation, poor engagement in care and reduced life expectancy.
Previous research has shown that many suicide victims had been in contact with healthcare services in the 12 months before their death.
In South Africa, where most people with HIV receive care in public sector facilities, Rabie said opportunities to screen for and prevent suicide in community-based HIV care settings remain under-utilised.
Other stressors, he said, “include rejection after disclosing HIV status and broader social pressures like unemployment and financial hardship”.
The study identified a lack of routine suicide screening and limited training in suicide risk assessment among primary healthcare workers as key barriers to prevention.
The researchers proposed two additional strategies to strengthen suicide prevention among HiV+ people. The first is the integration of mental healthcare into HIV clinical settings, which Rabie said could play a critical role in early identification and prevention.
The second strategy involves brief, targeted interventions to support primary healthcare workers, including counselling programmes focused on psycho-education around suicide risk factors and coping strategies.
“The findings from this study will inform the development of a brief intervention that introduces safety planning to reduce suicide risk and training in adaptive coping skills,” Rabie said.
“In partnership with the City of Cape Town and the Western Cape Department of Health and Wellness, this intervention will be pilot-tested in primary healthcare facilities across the Cape Metro in 2026.”
The study was supported by the Fogarty International Centre and the National Institutes of Mental Health in the United States.
Study details
Suicide among people with HIV: primary healthcare workers’ perspectives on risk factors, barriers to care, and suicide prevention needs in South Africa
Evelina Dencker, Ingrid Rystedt, Patrik Rytterström and Stephan Rabie.
Published in Aids Care on 5 January 2026.
Abstract
Background
Suicide disproportionately affect people with HIV. To prevent suicide, it is crucial to enhance our understanding of the etiology of suicidality and develop prevention strategies for people with HIV. This study explored healthcare workers’ perspectives on risk factors, barriers to care, and prevention needs in primary healthcare settings in South Africa.
Methods
We conducted semi-structured interviews with 13 healthcare workers from three primary healthcare clinics in Khayelitsha. The interviews were audio recorded, transcribed verbatim, and analysed using a reflexive inductive thematic analysis.
Results
The findings demonstrate that suicide among people with HIV is influenced by several factors including fear of disclosure, HIV-related stigma, comorbidity with psychiatric disorders, and social stressors. The clinics lack routine screening for suicide, insufficient training in suicide risk assessments for healthcare workers, and have limited trained mental health professionals. Combined, these inadequacies result in missed identification and lack of necessary support for patients at risk of suicide, which in turn cause frustration and helplessness among healthcare workers, negatively affecting their mental well-being.
Discussion
Our research highlights the importance of implementing interventions in primary healthcare settings to support individuals with HIV at risk of suicide. Our findings emphasise the need to integrate mental health services into regular HIV care to ensure proper identification of people at risk of suicide, as well as the need to implement preventive measures for this population.
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