As 2019 draws to a close, TheBodyPro takes stock of the year's most noteworthy developments in HIV. And not just any developments: We're looking specifically at those with the largest impact for people who provide HIV care and services in the U.S. In this series, veteran clinician-researcher David Alain Wohl, M.D., guides us through the new research and other important moments of 2019 that have the greatest potential to alter the HIV clinical landscape in the months and years to come.
Sadly, life expectancy in the U.S. is in a decline. This is an amazing statistic given the advances in medicine we have achieved and the abundance of resources in this nation. However, driving the recent downward trend in this indicator of national well-being is not an infectious disease or cancer, but drug overdoses and suicide -- especially among white men and people in rural areas.
For people living with HIV infection, the same seems to hold.
Data from the large NA-ACCORD cohort show that from 2000 to 2015, rates of suicide were almost always much higher among white men living with HIV than white men in the general population. Not surprisingly, HIV-positive white men who inject drugs had the highest suicide rates.
In contrast, HIV-positive black men take their own lives at a similar rate as black men in the general population. Women in the cohort who were living with HIV were found to commit suicide at rates below those in the general population.
The Bottom Line on HIV and Suicide Trends
These sobering data make clear that in the clinic, depression screening is as important as STI screening. Writ large, though, the increase in suicide and drug overdoses shows us clearly what is not going so great in America. These are statistics of despair and hopelessness, but also of threadbare resources in places of greatest need; the broken mental health system; and the consequences of a health care industry that considers medical care a commodity rather than a basic human right.
Once again, HIV peels back what a society would rather hide. For people living with HIV infection, the strains of stigmatization and isolation are multipliers that compound already high rates of depression and substance use. Other data point to loneliness, especially among older people living with HIV.
Advances in therapeutics add years of life, but that for too many it is a hollow victory. This is not what the activists fought for: survival without purpose, connections, or support. As we then advocated for more research toward HIV treatment and a cure, we now need to demand more services for those at risk and those in need.