UCT study highlights urgent need to integrate mental health support into HIV care

A new study by researchers at the University of Cape Town (UCT) and Linköping University in Sweden has found that people living with HIV face a heightened risk of suicide, underscoring the urgent need to integrate mental health services into routine HIV care.

The research, published in the AIDS Care journal, highlights how stigma, fear of disclosure, mental health challenges and gaps in primary healthcare services combine to increase vulnerability among people living with HIV.

The study explored healthcare workers’ perspectives on suicide risk factors, barriers to care and prevention needs within primary healthcare settings. Researchers conducted in-depth interviews with 13 healthcare workers from three primary healthcare 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 people living with HIV due to a complex interplay of factors.

“There isn’t one specific causal pathway that can explain why people with HIV are particularly vulnerable to die by suicide,” Rabie said. “Rather, people with HIV are confronted by a combination of situational stressors that compromise their mental health and increase their risk for suicide.”

He added that the elevated risk of mental illness and suicide has serious implications across the HIV care continuum, including delayed treatment initiation, poor engagement in care and reduced life expectancy.

Previous research has shown that many individuals who die by suicide had contact with healthcare services in the 12 months prior to their death. In South Africa, where the majority of people living with HIV receive care in public sector facilities, Rabie said opportunities to screen for and prevent suicide in community-based HIV care settings remain underutilised.

“Our findings showed that among people with HIV, suicidal ideation and behaviour are driven by a confluence of stressors,” Rabie said, “including rejection after disclosing HIV status and broader social pressures such as unemployment and financial hardship.”

Unlike high-income countries, where psychiatric disorders are often the primary drivers of suicide, low-resource settings such as South Africa face additional socioeconomic pressures, including food insecurity and poverty. Rabie said these challenges were strongly reflected in the current study.

One healthcare worker interviewed during the research noted: “Because sometimes you will find out it is not HIV [that is] the problem. There is something else other than HIV … the poverty at home, the lack of education, and now it is this burden of medication, or there is family violence at home.”

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.

“Providing opportunities for training in suicide risk assessment that are accessible and not burdensome to healthcare workers will be an important first step in addressing the syndemic of suicide in South Africa,” Rabie said.

The researchers also proposed two additional strategies to strengthen suicide prevention among people living with HIV. 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.

Given the overlap between psychiatric disorders, suicide risk and HIV, integrating mental health support into routine HIV care could help identify individuals in need of additional assistance earlier.

The second strategy involves brief, targeted interventions to support primary healthcare workers, including counselling programmes focused on psychoeducation 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.

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