DEATH FROM SUICIDE AND OVERDOSE AMONG DRUG INJECTORS AFTER DISCLOSUREOF FIRST HIV TEST RESULT

Objective: To investigate whether notifying injecting drug users (IDU) of their positive HIV serostatus contributes to suicide and overdose mortality risk. Design: Members of a cohort of IDU, recruited since De cember 1985, who first learned their HIV serostatus after study entry but before December 1992, were studied for incidence of deaths due to suicide and overdose. Methods: Incidence of mortality due to suicide/o verdose was calculated from date of first HIV test result disclosure u ntil the end of follow-up or diagnosis of AIDS. Results: Eighty-six HI V-positive and 252 HIV-negative IDU were included with median follow-u p times of 4.3 and 4.0 years, respectively. Seven suicides and 10 deat hs from overdose were recorded. High suicide/overdose risk shortly aft er test result notification was not found among HIV-positive IDU. Only one out of eight HIV-positive IDU who died of suicide/overdose died w ithin 6 months of first disclosure. The overall suicide/overdose morta lity rate was higher for HIV-positive than HIV-negative IDU, the rate ratio being 2.46 [95% confidence interval (CI), 0.95-6.39] or 2.04 (95 % CI, 0.77-5.39) after control for confounders. Conclusions: Notifying IDU of their positive HIV serostatus does not appear to lead to a sud den and substantial rise in suicide/overdose deaths. Although death fr om suicide/overdose is more common among HIV-positive than HIV-negativ e IDU, this difference is likely to result from factors other than tes t result disclosure. Therefore, provided that appropriate counselling is offered, we see no reason to discourage voluntary HIV test result n otification for fear of inducing suicide in HIV-infected IDU.