Demographic and Mental Health Predictors of HIV Care Outcomes Among Women Veterans

Understanding HIV care experiences of women veterans is essential for identifying gaps in an understudied population with unique care needs. Much of what is known relies on inferences from civilian women or combines women and men veterans, obscuring important sex-related differences. Mental health conditions are highly prevalent among women veterans and present a critical barrier to HIV care, as nearly half of Veterans Health Administration (VHA)-enrolled women veterans have at least one mental health diagnosis. This retrospective study analyzed a national cohort of 1255 women veterans with HIV from fiscal years 2022-2023. Logistic regression models examined associations between demographic and mental health characteristics and subsequent HIV care continuum outcomes (receipt of care, retention in care, and viral suppression), and one-sample binomial tests compared cohort outcomes to 2022 VHA-wide estimates. Among our cohort, 70.4% of women received care, 45.0% were retained, and 57.5% achieved viral suppression, each significantly lower than VHA-wide estimates (all ps < 0.05). Viral suppression among those with a viral load test on record was 95.4%, significantly higher than the VHA-wide estimate. In adjusted models, White (compared to Black) and separated (relative to divorced) women had lower odds of care engagement (p < 0.05). Serious mental illness was associated with lower odds of receiving care, while depression and anxiety were associated with greater odds of receiving care (all ps < 0.05). These findings highlight demographic and mental health factors associated with HIV care outcomes and underscore the value of sex-disaggregated analyses for identifying disparities in this understudied population.