Project 467085

The goal of the HIV care cascade (diagnosis, linkage to medical care, receipt of care and antiretroviral therapy, and retention in care) is the achievement and maintenance of viral suppression. Maintaining viral suppression not only improves the individuals health but also eliminates the risk of transmission (undetectable = untransmissible). Poor mental health can negatively affect every stage of the cascade, thus presenting a challenge for both the individuals health and wellbeing and public health. Women living with HIV (WLWH), who constitute a quarter of people living with HIV in Canada and over half of the people living with HIV globally, are at higher risk for mental health conditions and worse overall mental health than both men living with HIV and the general population. Nevertheless, the mental health concerns of WLWH are less likely to be addressed. Furthermore, WLWH remain underrepresented in research on the syndemic of poor mental health and HIV. My thesis project aims to understand the impact of mental health conditions on womens trajectories through the care cascade and the gaps in mental health services available to this population. Using longitudinal data from the largest cohort study of WLWH in Canada, I will assess the association of depressive symptoms with movement of WLWH across the care cascade through multistate Markov models. I will also examine the access to and use of mental health services among WLWH with mental health conditions, identifying factors associated with unmet needs for these services through regression analyses. These results will help generate recommendations for the management of mental health conditions among WLWH, thereby improving both mental health and HIV care outcomes.