Socio-structural barriers to mental health services among women living with HIV in Metro Vancouver, Canada.

Women living with HIV experience high levels of mental health conditions and gendered social and systemic inequities to healthcare services access. This study therefore examined the prevalence and socio-structural factors associated with being unmet need for mental health services among women living with HIV. Data were drawn from Sexual Health & HIV/AIDS: Longitudinal Women's Needs Assessment (SHAWNA), an open longitudinal community-based study among women living with HIV in Metro Vancouver (2014-present). Bivariate and multivariable logistic regression using generalised estimation equations were used to examine associations between socio-structural factors and unmet need for mental health services in the last six months. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. Overall, the study sample included 296 among 13 possible surveys with 1886 observations (2014-2023). In multivariable analysis, HIV-related stigma (AOR = 1.06;CI:1.03-1.08), food insecurity (AOR = 1.46;CI:1.04-2.04), being unable to access primary healthcare services (AOR = 1.42;CI:1.02-1.98), and gender-based violence (AOR = 1.89;CI:1.30-2.76) were significantly associated with unmet needs for mental health services. Addressing intersecting mental health and HIV stigma could help support safe disclosures of mental health conditions and facilitate referrals to care. Long-term, sustainable strategies to address shortages of primary care and affordable, trauma-informed mental health care services among women living with HIV are needed.