The Susceptibility of Suicide for HIV/AIDS-Positive Men

Presented to
The School of Education and Community Studies
University of Canberra

Field Study in Counselling Summary Report

Master of Arts in Counselling

By
Glen Rodden
University Of Canberra
2007

Supervisor: Dr Ione Lewis

Keywords: Acquired Immunodeficiency Disease

(AIDS), Human Immunodeficiency Virus (HIV), Men,
Suicide
 “Why me?”
The Susceptibility of Suicide for HIV/AIDS-Positive Men
Summary Report
University of Canberra, November 2007

Author: Glen Rodden, B.AppPsy, Grad.Dip.Counselling

Supervisor: Dr Ione Lewis, University of Canberra, Canberra ACT, Australia

Description:

“Why me?”
“How did this happen?”
“Who did this to me?”
“How long do I have?”
“What am I going to do?”
“Who am I going to tell? And, how?”

These questions are examples of some of the many doubts and uncertainties that arise
when someone is provided with a positive diagnosis of HIV/AIDS. The initial shock
and trauma of a positive diagnosis brings with it many emotions that certain health
professionals may or may not be able to deal with in their profession. The terminal
phase of AIDS or cancer is marked by a convergence of social stressors within several
months that is un-paralleled in the years of most person’s lives (Faulstich, 1987; cited
in Marzuk, 1994).

Suicide is complex, confronting and tragic for individuals, families, friends and
communities. It is an issue that affects Australians of all ages and from all walks of
life. The World Health Organisation has estimated that in the year 2000,
approximately one million people died from suicide and 10 to 20 times more people
attempted suicide worldwide (WHO, 1999). The LIFE Framework (Commonwealth
of Australia, 2000) identifies gay, lesbian and bisexual people, particularly
adolescents and young adults, as having substantially increased risk of suicide
behaviours and suicidal thinking (by a factor ranging from 3.5 to 14 times). Young
gay men and lesbian women have consistently higher rates of deliberate self-harm
than their heterosexual counterparts (Nicholas & Howard, 2001). Of this group,
young men and women who are confused or undecided about their sexual orientation
have the highest rate of deliberate self-harm and may not seek help for fear of being
judged or outed (Dyson, Mitchel, Smith, Dowsett, Pitts & Hillier, 2003).

Young gay men and lesbian women have consistently higher rates of deliberate self-
harm than their heterosexual counterparts (Nicholas & Howard, 2001). Those who
are open about their sexuality frequently experience abuse and rejection by family and
friends (Brown, 2002). Rivers (2000) states that bullying is a significant factor for
suicidal ideation and behaviours, and it is believed that a considerable amount of
bullying among teenage boys is homophobic. Some important points are discussed
with regards to the silence experienced by those who are same-sex attracted and the
additional silence experienced with suicide. There is definitely a gap in the evidence
base linking sexuality to suicidal and self-harming behaviour, however, the reviewed

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literature certainly defines sexuality and sexuality issues as a link to suicide and
suicidal behaviour.

An estimated 38.6 million people world-wide were living with HIV at the end of 2005
(UN, 2006). An estimated 4.1 million became newly infected with HIV and an
estimated 2.8 million lost their lives to AIDS (UN, 2006). Findings from studies with
HIV/AIDS-positive people have found that with progressive deterioration come
increasing demands for emotional and practical support, loss of social and sexual
relations, financial pressures and challenges of end of life symptoms. Research has
found that HIV infected persons are 7 to 60 times more likely to commit suicide than
their HIV negative counterparts (Heckman et al, 2002).

Data from studies reviewed suggest that the increased rate of suicidal behaviour in
HIV-infected persons is consistent with findings in other medically ill groups with
chronic, life-threatening disorders (Komiti et al, 2001). Those who had thought about
suicide also were more likely to have disclosed their HIV status to the people close to
them, and yet they perceived receiving significantly less social support from friends
and family.

Not enough information is provided on the immunological stage of HIV/AIDS

positive people who commit suicide, therefore there is no firm guide as to what stage
of HIV or AIDS that a patient starts to deteriorate and start rationalising suicide as a
means of ending suffering and discomfort. The most frequently cited reasons for
making plans to end life were to maintain a sense of control, the desire to make one’s
own decisions and to prevent suffering. Results from studies in euthanasia must be
considered within the context of Australian health care. Euthanasia is not legal within
Australia. However, from the perspective of this study, the question of
“preparedness” for death and the degree of trauma and suffering associated with the
patient’s death may be pertinent issues when examining family members who may be
at greater risk for a complicated grief response.

Little research has been undertaken to test the effectiveness of different counselling
interventions with individuals at risk for suicide associated with HIV/AIDS. The few
studies that have been reported and reviewed in this study have been conducted in
non-Australian care settings and are not recent, making it difficult to draw firm
conclusions regarding future service development for the Australian HIV/AIDS-
positive associated population. People who are living with HIV/AIDS experience
significant emotional distress and thoughts of suicide. The studies reviewed illustrate
a clear linkage between HIV/AIDS and suicide and important issues such as a
patient’s rationale for using assisted suicide or suspending treatment so that they may
reduce living with (sometimes) intense and uncomfortable pain and discomfort. With
respect to counselling and treatment interventions, continuity of care and ease of
referral to other specialists seem to suggest high protective factors when it comes to
HIV/AIDS-positive people opening up regarding their fears of dying and death.

This research project aimed to determine whether a small sample of males living with
HIV/AIDS in the Australian Capital Territory (ACT) were susceptible to thoughts,
feelings and behaviours of suicide; and to provide recommendations for counselling
and other community services in the ACT based on participants’ experiences of living
with HIV/AIDS.

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This was an exploratory qualitative study. The theory underlying the study was
Grounded Theory. Robson (2002) states that a grounded theory seeks to generate a
theory which relates to the particular situation forming the focus of the study. This
study consisted of two phases.

Aims & Objectives

This research project has aimed to determine whether a small sample of males living
with HIV/AIDS in the Australian Capital Territory (ACT) are susceptible to thoughts,
feelings and behaviours of suicide.

This project will examine the experiences of men living with HIV/AIDS and will aim
to provide guiding recommendations/principles for counselling strategies for people
affected by a life-threatening virus, in particular services providing counselling for
men living with HIV/AIDS.

The hope is to begin to address the gap in research about men living with HIV/AIDS
and their experiences of suicidal thoughts and feelings. This project will gather
qualitative data through interviews with men living with HIV/AIDS. The data will
then be analysed to develop guiding principles for counselling services and individual
counsellors based on the input and recommendations made by participants.

This project will contribute to the continuous improvement of men’s health and
counselling services through consumer input, as well as providing a basis for suicide
prevention activities in this area. And it is expected that this project will develop
knowledge which will be capacity building for AIDS councils in Australia, as well as
for services providing counselling to men, and more specifically, to this group.

This project aligns with several Action Areas of the LIFE (Living Is For Everyone)
Framework of the Australian Government’s National Suicide Prevention Strategy
(Commonwealth of Australia, 2000), namely:
• Action Area 1: Promoting well-being, resilience and community capacity
across Australia;
• Action Area 2: Enhancing protective factors for suicide and self-harm across
the Australian community;
• Action Area 4: Services for people at high risk; and
• Action Area 6: Progressing the evidence base for suicide prevention and good
practice.

The two objectives of this research were to establish whether men living with
HIV/AIDS in the ACT experience suicidal thoughts, feelings and behaviours, and to
provide recommendations for counselling and other community services in the ACT
based on participants’ experiences of living with HIV/AIDS.

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Method:

Phase 1:
Compilation and analysis/Literature review/search of existing information such as
documentation/journals/texts regarding:
• Suicidal behaviour in people with HIV/AIDS;
• Experiences influencing suicidal thoughts, feelings and behaviours; and
• The mental health and wellbeing of HIV/AIDS sufferers.

Phase 2:
Using the research accessed in Phase 1, the researcher:
• Developed an interview schedule;
• Collected qualitative data using semi-structured interviews with HIV/AIDS
infected males in the ACT region;
• Analysed data; and
• Wrote up the results of the research study.

Seven participants chose to take part in the research and were interviewed using
questions from an interview script. The interview was recorded on audio tape using
equipment connected to a telephone. All participants who took part in this research
were males living in the Australian Capital Territory and were 18 years or older at the
time of interview. Participants self identified during the interview as being diagnosed
with HIV/AIDS. Participants reported during the interviews that they were diagnosed
with HIV between 1985 and 2001.

Results:

Data was analysed using N*Vivo, a software program which facilitates the
identification and coding of themes and categories emerging from the data. The
following themes and categories were identified through using N*Vivo for data
analysis:
• Professional
• Mental Health
• Counselling
• Relationships
• Education
• Suicide

Study Limitations:

Data: There is limited data regarding the relationship between suicide and
HIV/AIDS. At present the most recent ABS data for suicide is
from 2004, this is due to the fact that State and local coroners
offices have delays in releasing the official cause of death and
inevitably do not supply the data in time for ABS to analyse
and publish.

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 Furthermore, Australian data for suicide deaths is normally
delayed by 12 to 24 months. This is because determining
whether the death is due to suicide is dependent on a Coronial
investigation. In addition, processes for deciding whether a
death is due to suicide seem to vary between States, Territories
and local areas.

Time: There is a finite time period and small sample size for this project which
decreases the scope and potential for research. However, this is
usual for qualitative study (Lewis, 2006).

Labor: The research scope is limited due to a single individual

undertaking research.

Money: Costs incurred by this research were limited to that of the

researcher’s available funds.

Confidentiality: There are possible privacy and confidentiality limitations with

regards to the collection of data for research purposes. An
outline of these issues is detailed in the next section of this
proposal.

In the presentation of this research project to fellow project students, the limitation of
researcher bias were raised in terms of a suspected preconception with respect to
research participants. The question of identifying depression or state of mind with
respect to suicidal thoughts was also raised with regards to research participant
responses to interview questions and how these might impact on the findings. To
resolve any question of bias, the researcher asked the research participants about their
mental health and wellbeing prior to their HIV/AIDS diagnosis. This established
whether the research participant had any prior mental health issues.

Conclusions:

It was found that there are clear linkages with the data findings of this study with that
of the reviewed literature. The main themes that are consistently raised by
participants were: future health concerns; disclosure and the ensuing stigmatization
and discrimination; the effect the diagnosis has on their lifestyle and social sphere;
and, the limitations on living that a positive diagnosis causes. With respect to the
counselling relationship, it was important for participants to have a close friendship
relationship with the counsellor especially when newly diagnosed. However, further
counselling should have a higher emphasis on education and provision of information.
For some participants it was important that the counsellor be familiar with the
participant’s point of view and even share a homosexual sexual identity or at the very
least be aware of the issues faced by homosexual men. However, for other
participants, a genuine counselling atmosphere and a counsellor who had an
understanding of HIV/AIDS was satisfactory.

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It was clear from the responses of the participants that counsellors working in this
area require an understanding of crisis counselling, as many participants experienced
an “initial shock” or trauma from being presented with a positive test result for
HIV/AIDS. However, each individual participant experienced the presentation of
their results differently, therefore, as with any counselling session, the counsellor
should be led by the individual as to how he is feeling at the time and how he is
coping emotionally with the news.

Recommendations:

It is recommended that counsellors should be:

• competent with respect to the HIV/AIDS illness (education and fact sheets
from the Australian Federation of AIDS Organisations www.afao.org.au can
assist with information about the virus and disease);
• become familiar with working with gay and lesbian individuals to gain an
understanding of the needs and experiences of this particular group of people;
• become familiar with the networks of HIV/AIDS and gay and lesbian groups
and organisations that exist to link clients with other people who may be in a
similar situation (if the client so desires);
• non-judgmental, HIV/AIDS does not discriminate and nor should the
counsellor;
• focus the client on the healthy aspects of his life and what their doctor or
specialist has outlined they should do (e.g. an action plan);
• explore ways the client can deal with situations such as disclosure and possible
stigmatisation and discrimination;
• determine what loss and grief therapy the client may need in the future; and
• always monitor the client’s thoughts and feelings of suicide and talk openly
about how the client may deal with these thoughts and feelings.

Additional Information:

Information regarding the LIFE (Living Is For Everyone) Framework for Suicide
Prevention in Australia: www.livingisforeveryone.com

Information relating to HIV/AIDS and HIV/AIDS Statistics can be obtained from

UNAIDS (United Nations): www.unaids.org/en/

Information relating to HIV/AIDS services and support in Canberra, ACT, can be

obtained from the AIDS Action Council of the Australian Capital Territory:
www.aidsaction.org.au

Additional information regarding this study or to obtain a copy of the full report,
contact: Dr Ione Lewis, School of Education and Community Studies, University of
Canberra, Canberra, ACT.

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References*:

Australian Bureau of Statistics, (2003). Suicids: Recent Trends, Australia.

Australian Bureau of Statistics. (2006) Suicides: 1994 to 2004, Commonwealth of

Australia.

Brown, R. (2002) Self Harm and Suicide Risk for Same-Sex Attracted Young People:
A Family Perspective, Australian e-Journal for the Advancement of Mental Health,
1(1)

Commonwealth Of Australia (2000), LIFE: Living Is For Everyone – A framework

for prevention of suicide and self-harm in Australia.

Dyson, S., Mitchell, A., Smith, A., Dowsett, G., Pitts, M., Hillier, L. (2003) Don’t
Ask, Don’t Tell – Report of the Same-Sex Attracted Youth Suicide Data Collection,
Monograph Series No. 45, The Australian Research Centre in Sex, Health and
Society, La Trobe University, Melbourne.

Heckman, T.G., Miller, J., Kochman, A., Kalichman, S.C., & Carlson, B. (2002),
Thoughts of Suicide Among HIV-Infected Rural persons Enrolled in a Telephone-
Delivered Mental Health Intervention, Annals of Behavioural Medicine 24(2),pp141-
148.

Komiti, A., Judd, F., Grech, P., Mijch, A., Hoy, J., Lloyd, J.H., & Street, A. (2001)
Suicidal Behaviour In People With HIV/AIDS: A Review, Australian and New
Zealand Journal of Psychiatry, 35, pp.747-757

Marzuk, P.M. (1994) Suicide and Terminal Illness, Death Studies, 18, pp. 497-512

Nicholas, J., Howard, J. (2001) Same-Sex Attracted Youth Suicide: Why Are We Still
Talking About It? Suicide Prevention Australia National Conference, Sydney.

Rivers, I (2000) “The long term consequences of bulling” in Neal, C. & Davies, D.,
Issues In Therapy with Lesbian, Gay, Bisexual and Transgendered Clients: Pink
Therapy Vol. 111, Open University Press, Buckingham.

Robson, C. (2005), Real world research (2nd Ed.), Blackwell Publishing: Victoria,
Australia.

UNAIDS, (2006). 2006 Report on the global AIDS epidemic, Joint United Nations
Programme on HIV/AIDS, United Nations.

World Health Organization. Figures and facts about suicide. WHO, Geneva, 1999.

*References list is for summary paper only.

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