“Everyone is fighting their own battles”: A qualitative study to explore the context of suicidal ideation among people with HIV (PWH) in Kilimanjaro, Tanzania

Tanzania faces significant HIV-related challenges with 1.4 million people currently living with HIV, 33,000 new infections, and 22,000 AIDS-related deaths annually. Suicide is a leading cause of death among People with HIV (PWH), with one-quarter of all deaths by suicide in Tanzania occurring among PWH. Despite this challenge, mental health resources are scarce, with only 55 psychologists and psychiatrists in the country, and clinic staff in HIV care lack adequate mental health training. This qualitative study explores the experiences of PWH who have recently had suicidal thoughts. The aim is to create targeted mental health interventions in Kilimanjaro. Participants were screened for suicidal ideation during routine care at two HIV clinics, with semi-structured qualitative interviews conducted thereafter. Data were analyzed using thematic analysis aided by NVivo 12 software. PWH experiencing suicidal ideation encounter multiple stressors related to their HIV diagnosis, societal stigma, financial stress, and broader social challenges. Suicide is sometimes viewed as an escape from these difficulties. Coping mechanisms include seeking assistance from family and religious leaders, but social support is hindered by fear of stigma. While participants expressed openness to counseling, treatment options were extremely limited. Suicide risk among PWH is influenced by stressors related to HIV, such as socioeconomic challenges, HIV stigma, low social support, and accompanying psychological distress. There is a clear need for improved mental health care options customized to the needs of PWH in Tanzania and other low-resource settings.