There is growing evidence that HIV infection and AIDS have an impact on a range of suicidal issues. The literature lacks clarity and the subject is traditionally problematic to research. True prevalence is often difficult to gauge and many researchers focus simply on death by suicide rather than exploring the extreme mental health burden brought about by suicidal thoughts, attempts, completions and bereavement. This study was set up to explore the nature and extent of problems in an unselected cohort of psychology clinic attenders (n = 188) in a London centre comprising 11% females and 89% males. For the cohort 21.4% had a suicide attempt recorded, 1 individual (0.5% of the sample) died by suicide and the level of suicidal ideation (both clear and vague) was noted for 50.5% of the sample. Suicidal issues were noted in 11.9% of referral letters from doctors. HIV seems to add an additional suicidal burden to this group where 43.9% attempted prior to HIV diagnosis, 41.5% after HIV diagnosis and 14.6% had attempts both pre- and post-diagnosis. The most common means involved overdosing. HIV related issues were often involved in triggers as was bereavement. There was a bimodal distribution of suicidal acts according to diagnosis with peaks at or around diagnosis and again at end stage illness. The data are discussed in terms of prevention, intervention and postvention with specific focus on the need to anticipate the mental health needs of people with HIV and AIDS as well as of their carers.