Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study

Abstract

Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families' expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM.

The changes and the predictors of suicide ideation and suicide attempt among HIV‐positive patients at 6–12 months post diagnosis: A longitudinal study

“…Our findings of the 21.6–27.2% occurrence rates of suicide ideation among HIV‐positive patients at 6–12 months post‐diagnosis were similar to the previous studies on newly diagnosed HIV‐positive patients ranging from 20.5% to 45.2% (Bitew et al., ; Li et al., ; Passos et al., ; Schlebusch & Govender, ). Differently, the previous studies on HIV patients diagnosed more than 2 years prior showed a range of suicide ideation from 8.8% to 14.0% (Amiya, Poudel, Poudel‐Tandukar, Pandey, & Jimba, ; Lewis, Mosepele, Seloilwe, & Lawler, ; Ogundipe, Olagunju, & Adeyemi, ).…”

“…This study and the previous studies consistently found that the higher levels of social support were associated with the lower occurrences of suicide ideation (Amiya et al., ; Barenbaum & Smith, ; Bitew et al., ; Li et al., ; Rukundo et al., ). Seeking social support is one of the effective coping strategies to prevent HIV‐positive patients from having suicidal ideation (Li et al., ; Rukundo et al., ). Research evidence has also shown that family support was predictive of a reduction in anxiety, stress, presence of depressive symptoms, and loneliness (Serovich, Kimberly, Mosack, & Lewis, ).…”

“…() found that 23.4% of these patients appeared to have suicide ideation and 2.4% of them had even undertaken a suicide attempt following the HIV diagnosis within 3 months. Another study reported that 14/31 (45.2%) of HIV‐positive patients expressed suicide ideation within 6 months after HIV diagnosis (Li, Tucker, Holroyd, Zhang, & Jiang, ). In summary, the previous studies have found the significant occurrence rates of suicide ideation and suicide attempt among HIV patients within 6 months of diagnosis.…”

Examining potential effects of non-occupational post-exposure prophylaxis (nPEP) on sexual behaviors of Chinese men who have sex with men: a cross-sectional study

“…In other words, these men may not trust their peers, which might be about an issue of stigma related to same-sex sexuality (e.g., spoiled identity) among these marginalized and stigmatized sexual minorities [40]. This is consistent with an ethnographic study among Chinese MSM reporting men internalized a stigma that MSM are bad and dangerous and MSM communities are disappointing and hopeless [41]. Participants whose , City = city of residence, Never married = never married, NPEP use = the use of NPEP, Internet = mainly looking for male sexual partners through the Internet.…”

Retention of a cohort of men who have sex with men and transgender women at risk for and living with HIV in Abuja and Lagos, Nigeria: a longitudinal analysis

“…Transactional sex involves a culmination of factors that contribute to a lack of engagement such as stigmas from commercial sex work and same‐sex sexual practices as well as power imbalances and socio‐economic vulnerability [44‐46]. These may co‐occur with mental health challenges, low self‐esteem and withdrawal [35,47]. Sexual and gender minorities with many of these vulnerabilities [48,49] may be less inclined to attend visits regularly.…”