“Everyone is fighting their own battles”: A qualitative study to explore the context of suicidal ideation among people living with HIV in Kilimanjaro, Tanzania

AbstractBackground: In 2020, Tanzania struggled with significant HIV-related challenges, including 1.4 million people living with HIV (PLWH), 33,000 new infections, and 22,000 AIDS-related deaths. Suicide emerged as a main cause of mortality among PLWH, accounting for over a quarter of all suicides. Despite these alarming statistics, mental health resources remained scarce, with only 55 psychologists and psychiatrists in the country. Clinic staff in HIV care were tasked with providing counseling despite limited mental health training, primarily focusing on HIV education. This study aimed to delve into the lived experiences of PLWH with recent suicidal ideation to inform tailored mental health interventions. Methods: Participants were screened for suicidal ideation during routine HIV clinic visits, with qualitative interviews conducted thereafter. Data was analyzed using thematic analysis facilitated by NVivo 12 software. Results: PLWH experiencing suicidal ideation encounter significant mental health challenges originating from factors such as their HIV diagnosis, societal stigma, financial stress, and broader social determinants. Death is sometimes perceived as an escape from the challenges associated with HIV. Coping mechanisms include seeking assistance from religious leaders. While participants expressed openness to counseling, limited treatment options hinder access. Conclusion: Suicide is an urgent public health challenge among PLWH in Tanzania, exacerbated by unique stressors like socioeconomic challenges, stigma, discrimination, and psychological distress. Despite the seriousness of these challenges, options for mental health treatment are scarce and not tailored to the needs of PLWH. Our findings can inform the improvement of mental health care for PLWH in Tanzania and other low-resource settings.

Key Words: Tanzania, HIV, Suicide, Suicidal ideation, Mental health, lived experience, Qualitative research, Stigma, Coping mechanisms, Counseling intervention, Socioeconomic challenges, Discrimination, Psychological distress, Treatment options and Low-resource settings.