Structural, Relational, and Psychosocial Vulnerability Profiles Shaping ART Engagement Among Women Living with HIV in Kenya

This study investigates how structural, relational, and psychosocial factors influence antiretroviral therapy (ART) engagement among women living with Human Immunodeficiency Virus [HIV] in Kenya. Using nationally representative data from the 2022 Kenya Demographic and Health Survey, we analyzed 332 HIV-positive women aged 15–49 years, applying a multidimensional outcome that combines ART use with measures of internalized stigma and exposure to harassment. Multivariable logistic regression and person-centered cluster analysis were used to identify determinants of enhanced engagement and to characterize distinct vulnerability profiles. The results show that women living in poverty and those with a history of anxiety had significantly lower odds of achieving enhanced ART engagement, despite ART being widely available and free. Cluster analysis revealed co-occurring vulnerabilities across structural, psychosocial, and reproductive domains, indicating that women can be “on ART” while remaining socially and psychologically vulnerable. These findings highlight that biomedical access alone is insufficient for meaningful engagement in care. Interventions that address socioeconomic constraints, mental health, stigma, and intimate partner violence are essential to support sustained ART engagement among women in Kenya.