Mental Health, Self-Care, and Engagement in Care among Black Women Living with HIV

Abstract

Objectives Due to sociostructural factors, Black women living with human immunodeficiency virus (HIV) in the United States represent the highest percentage of women with HIV and experience mental health struggles that impact health behaviors. This study examines associations between mental health, self-care, medication adherence, engagement with healthcare, HIV-related healthcare visits, and hospitalization. Methods One hundred and nineteen Black women living with HIV in the Southeastern United States completed measures on scheduled visits (general and HIV-related healthcare), visits attended/missed/rescheduled, mental healthcare engagement (therapy and support groups), hospital visits (emergency room and overnight stays), medication adherence, and a clinician-administered interview assessing mental health. Results Higher self-care was associated with fewer emergency room visits (β=−0.31, P<.001) and hospitalizations (β=−0.22, P<.05). Higher post-traumatic stress disorder symptoms were associated with hospitalization (β=0.23, P<.05) and missed HIV-related visits (β=0.20, P<.05) but higher outpatient mental healthcare visits for group psychotherapy (β=0.20, P< .05). Higher suicidality was associated with lower HIV-related healthcare visits scheduled (β=−0.26, P<.01). Higher HIV load was associated with higher HIV-related healthcare visits scheduled (β=0.45, P<.001) and hospitalization (β=0.41, P<.001). Higher Wisepill medication adherence (β=−0.28, P<.01) and self-reported adherence (β=−0.33, P<.001) were associated with fewer HIV missed visits. Higher self-reported adherence was associated with fewer emergency room visits (β=−0.38, P<.001) and hospitalizations (β=−0.27, P<.001). Conclusions Our findings highlight the need for treating mental health symptoms and enhancing self-care among Black women living with HIV to improve engagement in care and health behaviors and decrease emergency room visits and hospitalization.