In this second decade of the HIV/AIDS pandemic, HIV/AIDS will continue to be a predominant social work concern, but the public at large will generally remain apathetic. The impact of increasing infection and the ensuing public harm continues to mount. In the United States more people have died in the past 10 years from HIV/AIDS than in the Korean and Vietnam Wars combined (National Commission on AIDS [NCAIDS], 1991). Daily more than 100 people die of AIDS (NCAIDS, 1991). In January 1993, 4,278 new cases were reported to the Centers for Disease Control and Prevention (CDC, 1993), and the CDC has estimated that 1 in every 250 Americans is now HIV positive (Louisiana Office of Public Health, 1992). The number of people affected by HIV/AIDS continues to increase, draining an already financially beleaguered health care and social services delivery system (Ozawa, Auslander, & Slonim-Nevo, 1993).
The suicide rate among chronically and terminally ill people is higher than in the general population (Martin & Range, 1991). Marzuk et al. (1988) estimated the rate as about four times that of the general population and noted as examples that suicide rates related to Huntington's chorea (a central nervous system [CNS] disorder progressing to dementia) are three to 23 times higher and those related to kidney disease are 10 to 50 times higher.
The risk of suicide among people with psychiatric disorders is well documented (Cote, Biggar, & Dannenberg, 1992). HIV/AIDS often generates related psychiatric and neuropsychiatric sequelae, including depression and anxiety; the cumulative effects of extreme and chronic stress; and CNS manifestations from changes in affect, behavior, and cognition (Levenson, 1988) to dementia (Rundell, Paolucci, Beatty, & Boswell, 1988). Marzuk et al. (1988) reported that such CNS problems increased suicide rates. Feelings of helplessness and hopelessness are two signs of depression that occur in people with HIV/AIDS (Saunders & Buckingham, 1988). Depression often stems from people coping with multiple losses of friends and contemporaries from AIDS (Biller & Rice, 1990). Depression and stress can be alleviated by combinations of medical and psychosocial interventions (Engelhardt, 1986). Hence, some suicides are the result of reversible psychiatric or neurological aspects of the disease (Nichols, 1987).
Risk of AIDS-Related Suicide
Marzuk et al. (1988), using New York data; Kizer, Green, Perkins, Doebbert, and Hughes (1988), using California data; and Cote et al. (1992), using national data, found an increased risk of suicide in people with HIV/AIDS. Marzuk et al. found a 36 percent increase and Kizer and colleagues a 21 percent increase. Cote et al. found a 7.4-fold increase among people with HIV/AIDS as compared to demographically similar men in the general population. Cote et al. reported declining rates within their study time (1987 to 1989), perhaps because of declining stigma attached to the disease. However, it seems doubtful that the stigma of HIV/AIDS is declining; Herek and Capitanio (1993) studied U.S. public reactions to AIDS and found that stigma is still a serious problem. AIDS remains a metaphor for moral failure to many (Sontag, 1988).
Gay men may be at particular risk for suicide. Although the epidemiological characteristics of HIV/AIDS are changing and more women and people of color are now being affected, the early impact of the pandemic placed a particular burden on gay communities. The impact of AIDS on gay communities has been likened to a holocaust (Kramer, 1989). There is no adequate research base to examine suicide rates among gay men; among adolescent gay men, suicide rates are two to six times higher than among other adolescents (Harry, 1989). Substance abuse also increases the risk for suicide, and gay men may be at increased risk of substance abuse (Rofes, 1983). Combining the stress of oppression of gay men with the impact of HIV/AIDS enhances suicide risk. …