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

Manitoba's provincial HIV diagnosis rates are three times the national average, and Canada has reported increases in HIV diagnoses for five consecutive years since 2019.

• Canada has endorsed the UNAIDS target to end the HIV epidemic by 2030.
• Despite this target, Canada has reported consecutive annual increases in HIV diagnoses since 2019.
• Manitoba's provincial rates were reported as three times the national average.

Thematic analysis of semi-structured interviews with 32 people living with HIV in Manitoba revealed four major themes related to mental health and HIV care engagement.

• 32 Manitoban participants were included, comprising women, men, and gender-diverse people living with HIV.
• The study used semi-structured interviews focused on barriers and facilitators to HIV care.
• Quantitative measures on childhood trauma and empowerment were incorporated alongside qualitative methods.
• The four themes identified were: 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.

• Severe childhood trauma was among the hardships most commonly reported.
• Interpersonal violence, HIV stigma, and racism were also identified as major adversities.
• Socioeconomic-related stressors were reported as contributing to participants' hardship experiences.
• These adversities were described as likely synergistically exacerbating participants' current mental health concerns.

Substance use was identified as a coping mechanism among participants, and participants reported needing additional supports for substance use and mental health.

• Substance use as coping emerged as one of the four major themes from thematic analysis.
• Participants reported feeling supported by their HIV care providers but requiring additional supports for substance use and mental health.
• Precarious housing and traumatic experiences were also identified as factors interfering with engagement in HIV care.

Despite significant adversities, many participants described gaining empowerment and demonstrated resilience through health-promoting behaviors.

• Resilience and empowerment were two of the four major themes identified in the thematic analysis.
• Health-promoting behaviors included enlisting social supports as an example cited by participants.
• Participants demonstrated resilience and empowerment in their daily lives simultaneously with experiencing hardships.

The diverse adversities experienced by participants were found to worsen mental health and hinder HIV treatment engagement and adherence.

• The synergistic effect of multiple adversities was identified as undermining HIV treatment engagement and adherence.
• Mental health concerns among participants were described as being exacerbated by cumulative hardships.
• Social determinants of health such as housing were identified as interfering with engagement in HIV care.

The authors concluded that achieving UNAIDS targets requires implementing evidence-based mental health interventions and strategies that foster resilience and empowerment in people living with HIV in Manitoba.

• Future research should focus on strengthening resilience, empowerment, and mental health to improve outcomes for people living with HIV in Manitoba.
• The authors called for research and implementation of evidence-based mental health interventions.
• Integrated strategies addressing substance use, precarious housing, and traumatic experiences were identified as essential components.