Risk factors for suicide attempts in a clinic-based sample of people living with HIV in Puerto Rico Gerardo G. Jovet-Toledo a *, Michael C. Clatts a , Carlos E. Rodriguez-Diaz a , Lloyd Goldsamt b and Ricardo L. Vargas-Molina a a Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; b National Development and Research Institutes, New York, NY, USA (Received 15 October 2013; accepted 11 February 2014) Puerto Rico (PR) has a large and rapidly growing population of people living with HIV. However, relatively little behavioral or clinical research has been done in this population. As treatment for HIV increasingly moves into a chronic condition model, it is becoming increasingly important to understand the needs of this population so critical social and behavioral interventions can be developed, thus enabling the individual and community-level benefits of antiretroviral (ARV) treatment to be fully realized. To date, however, there has been very little research on the mental health needs of people living with HIV in PR, a fact that constrains intervention development and implementation. This paper describes data from a public sexually transmitted infection (STI) and HIV clinic study in the San Juan metropolitan area between April 2010 and December 2012 (n = 1185), roughly a third (36%) of whom are living with HIV. Descriptive statistics, chi-square, t-tests, and binary logistic regressions were used to assess associations between HIV status and a history of suicide attempt. The overall prevalence of a history of suicide attempt was 20.4%. No statistically significant relationship was found between a history of suicide attempt and being HIV positive, although people with HIV infection did evidence a higher prevalence of attempts than HIV-negative subjects (23.4% vs. 19.0%). Factors associated with having a history of suicide attempt within the overall sample included gender, current employment status, a lifetime history of drug use, and a lifetime history of sex work. Similar patterns were seen in the HIV-positive subsample. There was a nonsignificant trend toward increased risk for a post-diagnosis suicide attempt. These findings suggest that additional research on mental health risks among populations at risk for HIV in PR is needed. Keywords: suicide; HIV; mental health; Puerto Rico; people living with HIV Introduction Despite the success of antiretroviral (ARV) treatment in transforming HIV into a chronic, treatable condition, rates of suicide ideation and suicide attempts among people living with HIV are generally higher than among HIV negative or status unknown individuals (Keiser et al., 2010; Sherr et al., 2008). Several researchers have suggested that HIV-related stigma may contribute to social isolation and decreased quality of life, thereby contributing to higher rates of suicide among people living with HIV (MacQuar- rie, Eckhaus, & Nyblade, 2009; Nachega et al., 2012). Puerto Rico (PR) has the highest suicide rate among Hispanics in the USA (6.9 per 100,000) (Centers for Disease Control and Prevention [CDC], 2010). PR also has one of the highest incidence rates of HIV in the USA; almost twice that of the 50 states and 1.5 times the HIV incidence among non-PR Hispanics in the USA (CDC, 2009). Surprising given the confluence of these two trends in PR (high background HIV seroprevalence and incid- ence and high rates of suicide), there is relatively little detailed data on suicide in PR and hence little empirical foundation for guiding development of social policy and prevention programming for the island’s large and growing population of people living with HIV. Based on analysis of a limited amount of suicide-related data that derived from an ongoing epidemiological study in a publicly funded sexually transmitted infection (STI) and HIV treatment center in the San Juan metropolitan area, this paper provides a preliminary report of the prevalence of suicide among people living with HIV in PR and identifies key areas for future research and intervention development. Methods Details of the study design and methodology have been described elsewhere (Clatts et al., 2011). Briefly, study subjects were randomly selected from the patient waiting room at Centro Latinoamericano de Enfermedades de Transmisión Sexual, one of the largest STI/HIV screen- ing and treatment centers in the San Juan metropolitan area and invited to participate in a structured, survey interview. Eligibility was restricted to individuals who *Corresponding author. Email: gerardo.jovettoledo@upr.edu © 2014 Taylor & Francis AIDS Care, 2014 Vol. 26, No. 8, 1032–1035, http://dx.doi.org/10.1080/09540121.2014.894618