Suicide is among the leading causes of death in the United States. Sexual and gender minorities such as gay and bisexual men are consistently at higher risk for suicide attempts and suicide ideation compared to their heterosexual counterparts. Similarly, high rates of suicide attempts and suicide ideation have been well documented among people living with HIV since the onset of the HIV epidemic. Black sexual minority men living with HIV, a population with multiple minority identities, may have even higher rates of suicidality. Yet, there is a lack of information about suicidality among Black sexual minority men living with HIV, and little is known about the characteristics that increase the risk of suicide. Therefore, this analysis aims to examine the prevalence and factors associated with suicide attempts and suicide ideation among a sample of BSMM+.
We analyzed the baseline data of a randomized control trial of a community-developed, web-based mobile app intervention that aimed to address the social work and legal needs of BSMM+ (n=122). We measured suicide attempts and future risk of suicide behaviors using the Suicide Behaviors Questionnaire-Revised (SBQ-R). Descriptive statistics were used to present the prevalence of primary study outcomes. We conducted logistic and linear regressions to identify the correlates of past suicide attempts and factors associated with future risk of suicide behaviors. Results were reported as odds ratio (OR) with corresponding 95% confidence intervals (CI) for the bivariable models and adjusted beta for the multivariable model. Associations with p-values equal to or less than 0.05 were considered statistically significant.
Of all participants, the average age was 37.2, and 61.6% had at least a college degree. More than one-third (36.1%) were screened for high risk of suicide based on SBQ-R. Specifically, 17.2% ever attempted to kill themselves, and 11.5% ever planned to kill themselves. Among these, 48.6% thought about killing themselves in the last year. In the bivariable model, past suicide attempt is associated with victimization (OR=3.04, 95% CI: 1.06-8.42) and screened for anxiety (OR=2.75, 95% CI: 1.06-7.36). In multivariable linear regression, increased risk for future suicide behaviors was significantly associated with being harassed (adjust b=1.07, p<0.01), experiencing victimization (adjust b=1.84, p<0.01), and screened positive for depression (adjust b=1.12, p<0.01).
A large percentage of Black sexual minority men living with HIV in our study reported having attempted suicide in their lifetime, and nearly half of them had considered killing themselves in the past year. Our results pose critical implications for the development and implementation of prevention strategies in this population. We found that suicidality was associated with traumatic experiences, including harassment and victimization, and psychological illnesses such as experiencing depression and anxiety. Our findings suggested that culturally relevant mental health prevention and trauma-informed services need to be implemented that consider multilevel approaches to addressing the intersection between suicide ideation, violence, and psychological distress among Black sexual minority men living with HIV. HIV clinic should also promote suicide screening and support services.