Suicide among people with HIV: primary healthcare workers’ perspectives on risk factors, barriers to care, and suicide prevention needs in South Africa

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 thirteen healthcare workers from three primary healthcare clinics in Khayelitsha, South Africa. The interviews were audio recorded, transcribed verbatim, and analyzed 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 emphasize 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.