For many women living with human immunodeficiency virus (HIV), managing their health means navigating a complex web of challenges that extend beyond the virus itself. From dealing with stigma and past trauma to financial and caregiving responsibilities, addressing mental health struggles often takes a backseat. But new research highlights just how vital mental health care is in ensuring women with HIV stay engaged in treatment.
In a recent study, Alexandra De Pokomandy, associate professor at McGill’s Department of Family Medicine, found that women living with HIV who have access to mental health services tended to be more active in receiving treatment, calling for the inclusion of mental health support in HIV care.
HIV weakens the immune system, making it harder for the body to fight infections. If left untreated, it can give rise to acquired immunodeficiency syndrome (AIDS). While there’s no cure, antiretroviral therapy (ART) can effectively control the infection and allow people to live full and healthy lives.
However, HIV itself is not the only battle. Among people living with HIV, up to 68 per cent struggle with mental health conditions—with women disproportionately affected compared to both men with HIV and women without HIV. For women, the intersection of experiences of sexism, past trauma, and stigma only compounds the effect of poor mental health.
“There are so many aspects of life of women living with HIV that add on to each other and they just increase the experience of oppression,” de Pokomandy said in an interview with The Tribune.
Her team’s research found that poor mental health not only impacts the mental well-being of people with HIV, but also makes it less likely that they will seek and adhere to ART.
“[Mental health support] is going to benefit their entire health, including ability to optimize taking their treatment and reaching undetectable levels of viral loads,” de Pokomandy said.
The article also highlights differences in healthcare access between Canada and the U.S.. In Canada, many women living with HIV are recent migrants who might not be aware of available mental health services. In the U.S., the lack of universal healthcare makes cost another significant barrier to receiving HIV treatment.
“If people need to pay for mental health, they may have to prioritize other essential needs. But the barriers to mental health services are more than just the cost. Is it accessible? Sometimes it’s free, but there’s just no access,” de Pokomandy emphasized.
Even when services are available, lengthy waitlists, limited provider availability, and logistical challenges—like juggling multiple jobs or long travel distances—make it difficult for women to seek help. Many women also take on caregiving roles, making it difficult to prioritize their own mental health.
“They will prioritize their own basic needs, the needs of their children, or the people they care for. Mental health is kind of this ‘extra service,’” de Pokomandy noted.
Stigma remains one of the major barriers to seeking mental health support, particularly for women with substance use histories as well as HIV.
“If women have to explain their whole story to someone outside the HIV clinic and they feel [a] perceived stigma, they won’t go back,” de Pokomandy said. “Even just disclosing their story to somebody else, [there is] the fear that it will be disclosed to the community, or just the fear of the judgment.”
De Pokomandy and her colleagues found that most women seeking mental health support prefer to do so within their HIV clinic, yet even these services can be difficult to access.
She emphasized the need for further research into why women avoid mental health care, whether due to stigma, inadequate resources, substance use, or overwhelming life demands.
Ultimately, de Pokomandy calls on HIV clinics to take a more proactive approach in ensuring women receive the mental health support they need. Clinics must not only raise awareness of available services but also actively engage with their patients and adapt to their needs.
