# Vulnerability and non-adherence to treatment in cisgender women living with HIV/AIDS: a scoping review (2000–2024)

## TL;DR

This review explores how gender inequalities and social factors affect HIV treatment adherence in cisgender women and highlights the need for integrated solutions.

## Contribution

A conceptual model is proposed to explain how vulnerability contexts impact treatment adherence in cisgender women with HIV/AIDS.

## Key findings

- Stigma affects all levels of vulnerability and contributes to treatment non-adherence.
- Barriers include mental health, gender-based violence, and structural health system issues.
- A socio-ecological model is introduced to guide interventions addressing these challenges.

## Abstract

Cisgender women are disproportionately affected by HIV/AIDS due to structural gender inequalities and intersecting social determinants, which generate vulnerability contexts that act as barriers to treatment adherence.

A scoping review to map studies examining vulnerability contexts influencing antiretroviral treatment non-adherence and discontinuation among cisgender women living with HIV/AIDS. Searches were performed in PubMed, SciELO, Scopus, Web of Science, and gray literature. A total of 78 studies published between 2000 and 2024 were included.

Findings were organized across three vulnerability dimensions individual, social, and programmatic. Stigma emerged as a transversal element permeating all levels. Barriers included mental health conditions, substance use, pregnancy and postpartum dynamics, socioeconomic inequalities, gender-based violence, and structural barriers in health systems. A conceptual model, grounded in the socio-ecological perspective and the vulnerability framework, is proposed to illustrate how these factors interact to affect adherence.

Vulnerability contexts significantly shape women’s ability to maintain antiretroviral therapy. Addressing these challenges requires policies and interventions that integrate biomedical, social, and structural perspectives, while recognizing women’s autonomy and promoting equity in HIV care.

This scoping review was conducted according to a previously published protocol, registered at Open Science Framework (https://osf.io/2ah3x/).

The online version contains supplementary material available at 10.1186/s13690-026-01852-z.