The nine-year trajectory of suicidal ideation and its risk factors among people living with HIV in Hunan, China: a cohort study

People living with HIV/AIDS (PLWHA) are at elevated risk of suicidal ideation (SI). However, evidence on SI risk factors remains fragmented, primarily derived from cross-sectional studies, and long-term changes in SI and its determinants are not well characterized. We aimed to describe the changes in SI among PLWHA over a 9-year follow-up period after HIV diagnosis and to explore the long-term risk factors for SI. In this prospective, two-center cohort study in Changsha, China, 200 newly diagnosed PLWHA were consecutively recruited and followed at four time points: baseline (T0), 1-year (T1), 5-year (T2), and 9-year (T3). SI and psychosocial factors—including HIV-related stress, depression, anxiety, and social support—were assessed at follow-ups. Latent growth mixture modeling (LGMM) was used to identify trajectory classes for psychosocial factors, while ordinal logistic regression and generalized estimating equations (GEE) were used to assess the longitudinal correlates of SI . The cohort was primarily male (93.0%) and relatively young (53.0% aged 18–28 years). The cumulative incidence of SI over 9 years was 35.0%. Wave-specific SI prevalence fluctuated significantly: 25.0% (T0), 13.7% (T1), 24.4% (T2), and 10.2% (T3), reflecting a non-linear but overall decreasing trend (P lt; 0.001). In GEE models, SI was associated with MSM-related transmission (OR = 1.993, 95% CI: 1.083–3.668), higher HIV-related stress (OR = 1.027, 95% CI: 1.008–1.047), and lower social support (OR = 0.958, 95% CI: 0.932–0.986). Most participants were classified into low depression trajectories (56.5%), low-decreasing-anxiety trajectories (78.0%), low-HIV-related stress trajectories (93.0%), and decreasing-social support trajectories (89.0%). Compared with the low trajectory group, decreasing–increasing trajectories of depression (OR = 2.951, 95% CI: 1.462–5.954) and HIV-related stress (OR = 3.900, 95% CI: 1.289–11.787) were associated with higher SI risk. Although SI among PLWHA generally declined over nine years, it showed significant non-linear fluctuation tied to worsening depression and increasing HIV-related stress trajectories. These findings support sustained monitoring of stress and depressive symptoms across the HIV care continuum to identify high-risk individuals and deliver timely interventions. Strengthening social support may also contribute to suicide prevention among PLWHA.