Introduction In recent years, there has been observed an emerging epidemic of human immunodeficiency virus (HIV) and other blood-borne virus infections among injecting drug users (IDUs) in rural and suburban areas of Pakistan. The injectingusersarethosepeoplewhoinjectdrugs(PWIDs) through veins and muscles. They are the most deprived and marginalised segment, neglected from the loved ones,societyandalsofromthegovernment.Lackofsocial supportfromfamilyandcommunityoftenforcePWIDsto commitsuicide.Suicidalbehaviourincludesthethoughts to killing self, including planning and thinking of suicide. Sometimesitonlyinvolvesthoughtsanddoesnotinclude thefinalactofkilling. 1 Generally, injecting drug users are considered the most miserable,bothmentallyandhealth-wise,intheaddiction community.Mentalhealthisastateofwell-beinginwhich apersonrealiseshisorherownpotential.Ithelpsaperson to cope well with life stressors and can contribute for the betterment of society. 2,3 Coping strategies are basically psychological and behavioural efforts which help people tominimiseortoleratethestressfullifeevents. 4 TheincidenceofHIVinfectionhasbeenreportedtobe5to 10 percent higher among the injecting drug users globally. Ontheotherhand,halfoftheHIVcaseshavebeenreported positive in injecting drug users in countries like Belarus, China,Italy,Poland,Spain,RussiaandEasternEurope. 5 In Pakistan, there are about three million drug users, representing2.3%ofthetotalpopulation.Furthermore,drug usethroughinjectionshasbeenfoundtobeamajorcauseof HIV transmission as well. Like other Asian countries, in Pakistan HIV is highly prevalent among PWIDs. The major causesarepoorknowledgeofHIVmodesoftransmissionand unsafeinjectingpractices.ItsprevalenceinPakistanisonthe rise. Besides, around 37.8% persons of the total population areinjectingdrugusers,outofwhich46.2%liveinGujrat. 6 Similarly, a study was conducted on the health-seeking behaviours of 120 injection users in Pakistan. 7 It focused on the participants' knowledge of the risks of drug injections and their insight regarding health-seeking behaviour,socio-demographicalfactorsandengagement in sexual behaviours. Overall, the results of that research showed lack of awareness among participants regarding risk-taking behaviours due to which they were at greater risktoacquireHIV. Studies conducted all over the world exploring the relationship between drug abuse and mental health problems revealed that there are a number of psychiatric Vol. 67, No. 4, April 2017 568 ORIGINAL ARTICLE Coping strategies, mental health and HIV status: Predictors of suicidal behaviour among PWIDs BushraAkram,MubeenIlyas Abstract Objective: Tounderstandsuicidalbehaviouramongpeoplewhoinjectdrugs. Methods: Thiscorrelational,cross-sectionalstudywasconductedintwoPakistanicitiesofGujratandJhelumfrom October 2015 to March 2016, and comprised male injecting-drug users aged18-60 years. Multistage systematic randomsamplingmethodwasused.Urdu-translatedversionsofthebriefcopeinventory,mentalhealthstatusscale andsuicidalbehaviourquestionnaire(revised)wereadministered.SPSS16wasusedfordataanalysis. Results: Of the 200 participants, 83(41.5%) were aged 26-32 years. The prevalence of human immunodeficiency virus was in 94(47%) cases. Suicidal behaviour was positively associated with psychological distress and human immunodeficiency virus status (p<0.05), whereas it was negatively associated with mental health, psychological well-beingandcopingstrategies(p<0.05).Regressionanalysisshowedmentalhealthindexandpsychologicalwell- being were negative predictors, whereas psychological distress and human immunodeficiency virus status were positivepredictorsofsuicidalbehaviouramongtheparticipants(p<0.05). Conclusion: Thelevelofstressledpeoplewhoinjectdrugstowardssuicidalbehaviour.However,thelevelofstress variedaccordingtotheseverityofhumanimmunodeficiencyvirusandpoormentalhealth. Keywords: Suicidal behaviour, Mental health status, Injecting drug users, Human immunodeficiency virus. (JPMA67:568;2017) University of Gujrat, Pakistan. Correspondence: Bushra Akram. Email: bushra.akram@uog.edu.pk