# Trauma, empowerment, and resilience: understanding the mental health concerns of people living with human immunodeficiency virus in Manitoba

## TL;DR

This study explores how trauma, empowerment, and resilience affect mental health and HIV care engagement among people living with HIV in Manitoba.

## Contribution

The study identifies mental health barriers and facilitators to HIV care engagement in Manitoba, emphasizing the role of trauma and resilience.

## Key findings

- Participants reported significant hardships, including trauma and stigma, which negatively impact mental health and HIV treatment adherence.
- Resilience and empowerment were observed through health-promoting behaviors and social support.
- Additional mental health and social support services are needed to improve HIV care engagement.

## Abstract

Canada has endorsed the Joint United Nations Programme on HIV/AIDS (UNAIDS) target to end the HIV epidemic by 2030. However, Canada has reported increases in HIV diagnoses for five consecutive years since 2019, with Manitoba’s provincial rates three times the national average. This study examines mental health factors that may impact engagement in care among people living with HIV in Manitoba.

For this qualitative study, 32 Manitoban women, men and gender-diverse people living with HIV completed semi-structured interviews on barriers and facilitators to HIV care; as well, we incorporated quantitative measures on childhood trauma and empowerment. Thematic analysis revealed four themes: experiences of hardship, substance use as coping, resilience, and empowerment.

Most participants reported experiencing numerous hardships, including severe childhood trauma, interpersonal violence, HIV stigma, racism, and socioeconomic-related stressors. These adversities likely synergistically exacerbate participants’ current mental health concerns, undermining HIV treatment engagement and adherence. Despite these challenges, many participants described gaining empowerment and demonstrated resilience through health-promoting behaviors (e.g., enlisting social supports). A key sentiment among participants was that while they feel supported by their HIV care providers, they require additional supports for substance use, mental health, and social determinants of health such as housing, which interfere with engagement in HIV care providers, they require additional supports that address key social determinants of health, including substance use, precarious housing, and mental health support to address traumatic experiences, as these factors interfere with engagement in HIV care.

The diverse experiences of participants may worsen mental health and hinder HIV treatment engagement. However, simultaneously, participants demonstrated resilience and empowerment in their daily lives. Future research should focus on strengthening resilience, empowerment, and mental health to improve outcomes for PLHIV in Manitoba.

To achieve the UNAIDS targets, it is essential to conduct research and implement evidence-based mental health interventions, along with related strategies that foster resilience and empowerment in this population.