Mental Health Implications of an Initial HIV Diagnosis: A Narrative Inquiry

Background and Purpose:

Despite medical advancements in HIV care leading to increased longevity of life, individuals with a diagnosis of HIV experience heightened suicidality. Managing suicidal ideation can pose a significant challenge, underscoring the importance of the lived experiences following the initial diagnosis. The research study emerged from a concern of increased likelihood of suicide attempts among individuals living with an HIV diagnosis. To improve interventions for the recently diagnosed, researchers must explore the experiences of mitigating suicidality through their stories of mental health, coping, and social support. The purpose of this narrative study is to explore the stories of people who recently learned of an HIV diagnosis and their experiences mitigating suicidal ideation.

Methods:

This qualitative study utilized a narrative inquiry approach. Using a purposive sampling design, eight individuals who were newly diagnosed with HIV and self-reported experiencing suicidality after learning of their diagnosis were recruited from an HIV care and advocacy organization. # self-identified as Hispanic and one as African American, and # self-identified as male, # as female, and # reported as LGBT. Study participants completed in-depth semi-structured interviews, and the audio was transcribed verbatim. The transcripts were analyzed thematically using NVivo software, where specific attention was placed on the storyline of participants' experiences. Coding focused on vignettes that told of important characters, the plot, and major epiphanies in their stories of this experience of mitigating suicidal ideation. Participant checking was utilized in the data analysis process.

Results:

The participants' storylines told of the “Initial Emotional Responses” to the diagnosis where most participants experienced acute suicidal thoughts within the first year of diagnosis, with social isolation complicating their experiences mitigating suicidality. Many participants' stories revealed that mental health services were not integrated into their HIV care, leaving them to navigate suicidality “Without Adequate Access to Mental Health Services”. “(self)Stigma and social support” emerged as a significant barrier to utilizing social support for mitigating suicidality, with most participants avoiding disclosure and fearing their friends and family’s rejection. Conversely, those with strong networks relayed storylines that attributed their “Resilience” and fewer thoughts of suicide due to their social support. In their storylines, mitigating suicidality requires “Immediate and Ongoing Support”.

Conclusions and Implications:

The study findings support immediate changes to integrate mental health services into HIV care at the moment of diagnosis, and especially within the first year for people recently diagnosed and mitigating suicidality. The implications of the study emphasize the role of social workers in providing immediate psychoeducation, conducting routine mental health screenings, and connecting newly diagnosed individuals with supportive programming. Healthcare policy reform should include mental health service provision as a standard component of HIV care. By addressing practice and policy, social workers and other health professionals can improve long-term mental health outcomes and reduce suicidality among individuals newly diagnosed with HIV.