PURPOSE:To explore nurses' experiences caring for older people living with HIV (OPLWH). METHOD:Individual semi-structured interviews were conducted with 15 nurses to explore their perspectives, challenges, and insights related to providing care for OPLWH. RESULTS:Using thematic analysis, we identified seven themes that were further organized into four overarching domains to enhance coherence and alignment: (1) Health Care System and Structural Challenges, (2) Clinical and Functional Care Needs, (3) Psychosocial Care and Experiences, and (4) Workforce Capacity and Training. These domains reflect the interconnected nature of system-level, clinical, psychosocial, and provider factors influencing the care of OPLWH. CONCLUSION:Findings highlight the importance of interdisciplinary care models, the integration of mental health and social needs assessments in nursing practice, professional education systems to address the intersection of aging and HIV, and advocacy by nurses to promote holistic and patient-centered care for OPLWH.

Carotid artery stiffness has been associated with cognitive performance; however, the association among men with HIV (MWH) remains unclear. We examined the relationship between carotid artery distensibility and cognitive performance in the Multicenter AIDS Cohort Study (MACS). We analyzed data from 717 men (459 MWH and 258 men without HIV [MWoH]) who underwent carotid artery ultrasound and completed neuropsychological testing at least twice. Carotid artery distensibility was divided into tertiles. Cognitive outcomes included psychomotor speed (Trail Making Test A), executive function (Trail Making Test B), and processing speed (Symbol Digit Modalities Test). Multivariable mixed effects linear regressions were used to estimate longitudinal associations between distensibility tertiles and cognitive scores, with adjustments for socio-demographics, cardiovascular risk factors, and HIV-related characteristics. Regardless of HIV serostatus, lower vascular distensibility was associated with older age, higher systolic and diastolic blood pressure, and greater prevalence of cardiometabolic risk factors. In fully adjusted analyses, lower carotid artery distensibility was significantly associated with slower performance on Trail Making Test A and B in MWH. These associations were weaker and not statistically significant among MWoH perhaps due to low sample size. In the combined sample, the rate of decline in executive function with age was similar across distensibility tertiles, but absolute scores were lowest in the low distensibility group. Lower carotid artery distensibility is linked to worse cognitive performance among MWH, suggesting that vascular aging may compound HIV-related cognitive decline.

Abstract Background Despite effective antiretroviral treatment, neurocognitive impairment (NCI) and functional disability remain concerningly prevalent among people living with HIV (PLWH). Despite this, there are currently no adequate evidence-based treatments targeting NCI in PLWH who reside in low- and middle -income countries. This is a major public health concern given that most the global population of PLWH is concentrated in those countries. Studies emerging from high-income countries of the global north suggest that different forms of cognitive remediation therapy (e.g., compensatory cognitive training [CCT] and restorative computer-based cognitive remediation training [CCRT]) may be helpful in treating NCI in PLWH. This developmental pilot study is the first to culturally adapt and pilot test a CCT approach (CogSMART) and a CCRT approach (BrainHQ©) for use in African PLWH. Method Forty-three participants (mean age = 41.1 ± 5.4 years) were randomized into either an intervention group (n = 27) or a matched-contact control group (n = 16). All participants completed a neuropsychological test battery and self-report measures of mental health and everyday functional competencies at baseline and at study exit. Participants assigned to the intervention group completed 10 CogSMART and 20 BrainHQ© sessions over the 5 weeks between baseline and exit testing. Results A significantly smaller proportion of intervention-group participants met criteria for neurocognitive impairment at study exit (30%) than at baseline (70%). Mixed-model analyses detected a significant and a noteworthy time x group interaction effect for the two cognitive outcomes, Global Deficit Score (p < 0.001) and delayed verbal memory (p = 0.050). In both cases, intervention-group participants made greater cognitive gains than controls participants over the 5-week trial period. Conclusions Culturally adapted cognitive remediation therapy shows good potential to reduce symptoms of NCI among South African PLWH. Reduction of such symptoms could, in turn, lead to better quality of life and other functional and health improvements. However, the current results must be replicated using larger-scale randomized controlled trials in the same setting. Future research should also seek to better understand the barriers to, and facilitators of successful implementation of neurorehabilitation interventions for NCI among PLWH in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT06466642.

BackgroundRepeated exposure to odorants through olfactory training (OT) and aromatherapy (AT) represents a noninvasive approach for psychological well-being.ObjectiveThis scoping review investigated how OT/AT can be used to reduce depressive symptoms, summarized intervention characteristics reported in the literature, and pointed out gaps in the literature.MethodsA scoping review of the literature published between 2000 and 2026 was conducted using a broad search across PubMed, CINAHL, Scopus, and PsycINFO based on inclusion/exclusion criteria on June 17, 2025, and April 13, 2026. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, 29 peer-reviewed interventional studies examining depressive symptomatology outcomes were synthesized.ResultsMost studies (e.g., 22/29) demonstrated improvements in depressive symptomatology (Cohen's d = -0.90 to 1.56; mean Cohen's d = 0.41); however, these effects were not consistently greater than control conditions, as several studies reported only within-group improvements. Results varied likely due to protocol differences (i.e., OT/AT sessions per day/week, odorant types, total intervention durations, measurement tools). Assessing adherence to OT/AT was challenging due to incomplete reporting across studies.ConclusionsThe OT/AT are simple, noninvasive, and relatively affordable interventions for reducing depressive symptoms in several vulnerable populations, except in clinically diagnosed depressive outpatients with moderate symptom severity. The OT/AT aligns with holistic nursing principles by integrating the sensory and emotional components to improve mental health and overall well-being. There is a lack of methodological standardization and inconsistency in monitoring adherence to OT/AT; thus, more rigorous randomized controlled trials are needed to examine its therapeutic benefit.ImpactThis scoping review contributes to future nursing research priorities and provides evidence for integrating OT/AT into holistic nursing practice.

BACKGROUND:There is a gap in knowledge regarding self-esteem in US adolescents in the context of depressive symptoms and overweight and/or obesity status. Self-esteem can potentially play a role in the relationship between obesity and depressive symptoms, which are both increasing in prevalence in US adolescents. The aim of this scoping review was to understand the extent of evidence in relation to self-esteem in this context. METHODS:Using the Arksey and O'Malley framework, a total of 717 articles were identified from seven databases, 593 unique studies were screened after duplicates, 86 full text articles were retrieved and assessed for eligibility, and 37 articles were included in the review. Two independent reviewers screened each article, and a third reviewer served as a tiebreaker. FINDINGS:Several factors were associated with self-esteem in this context, including family dynamics, puberty, teasing, sports participation, eating disorders, stressors, and body satisfaction. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:School-based screening and interventions can be conducted by school nurses, counselors, physical educators, food services, mental health team members, and other school health professionals. These professionals can also help to create a supportive environment in which bullying is not tolerated, physical activity and sports participation are promoted, and healthy food is provided. CONCLUSIONS:Future research is needed to better understand the link between self-esteem and depressive symptoms and weight status. When caring for children with obesity or overweight status and depressive symptoms, school health professionals should assess for low self-esteem, family dynamics, and cohesion.

Cognitive intraindividual variability (IIV) refers to the variability in one's ability to sustain consistent cognitive performance. This phenomenon is linked to the emergence of cognitive impairment and dementia. The aim of this concept analysis using Rodger's evolutionary approach was to clarify the unique characteristics of the concept of cognitive IIV in HIV care and research. PubMed, Embase, CINAHL, and PsycINFO were utilized which yielded 22 articles that were analyzed to inform the concept analysis. After considering antecedents, attributes, and consequences, many antecedents may also function as consequences, depending on how they influence or are influenced within the cause-and-effect process. This concept analysis highlights the potential of cognitive IIV as a sensitive indicator of cognitive health in people with HIV (PWH). A better understanding of the variation of cognitive performance in PWH will assist mental health professionals in developing more tailored interventions and achieving improved clinical outcomes.

INTRODUCTION:Some people with HIV (PWH) experience brain changes that affect neurocognition, but little is known about how HIV impacts social cognition or related brain regions. Social cognition, the ability to perceive, understand and respond to social information, is important for maintaining relationships and quality of life. This article provides the protocol for the first comprehensive study examining social brain function in PWH and people without HIV (PWoH). With three aims, this study will: (1) examine neural circuits related to social cognition; (2) examine social cognitive performance across two social cognitive domains and (3) examine the role of social cognition in everyday social functioning. METHODS AND ANALYSIS:Referred to as Social Brain Health Study in HIV Study, this cross-sectional study will enrol 105 PWH and 105 demographically matched PWoH aged 18-65 years. The study administers a comprehensive assessment battery across two visits within a 2-week period. Visit 1 includes behavioural measures of social cognition (Perceiving Social Cues and Understanding Others), neurocognition and social functioning (social network size and loneliness). Visit 2 involves functional MRI procedures with three social cognitive tasks designed to activate key brain regions (ie, fusiform face area, superior temporal gyrus, temporo-parietal junction, dorsal medial prefrontal cortex). ETHICS AND DISSEMINATION:This study was funded by the National Institute of Mental Health (MH139613) and approved by the Institutional Review Board of the University of Alabama at Birmingham (IRB-300013394). Data collection is ongoing. The first results are expected to be submitted for publication in 2030. Findings of this study will be published in peer-reviewed journals and presented at local, national and international conferences as well as patient organisations such as AIDS service organisations and community talks.

IntroductionPrevious studies suggest that cognitive remediation training (CRT) programs can help address neurocognitive impairment (NCI) and associated functional challenges in multiple populations. However, no such program has been developed for persons living with HIV in low- or middle-income countries (LMICs).MethodsIn this qualitative study, we aimed to describe how South African people living with HIV perceived and experienced the local adaptations of two US-designed CRT programs. We recruited 34 people living with HIV (27 women; age 30–50 years) from community healthcare clinics and a non-governmental organization. All had Xhosa as their home language, resided in low-income communities, and experienced at least mild NCI. Over a 5-week intervention period, participants completed ten 2-h Cognitive Symptom Management and Rehabilitation Therapy (CogSMART-SA) group sessions and 20 self-guided 30-min BrainHQ© sessions. Post-intervention, we hosted nine focus group discussions (3–5 participants each). We applied thematic analyses to the textual contents of those discussions, using decolonial community psychology frameworks (i.e., focusing on community needs and alternative approaches to researching historically marginalized groups, as well as on collaboration and community engagement through exchanges of culturally and socially relevant ideas).ResultsMost participants agreed the CRT programs were enjoyable, improved their mood, and assisted memory performance. They reported that the interventions helped address long-standing challenges (e.g., social exclusion, internalized stigma, and difficulty managing HIV). Many specified that the interventions helped improve self-care (e.g., via physical exercise and stress management techniques, and by ensuring medication adherence) and indicated a sense of increased agency and empowerment in a stigmatizing society. Moreover, they perceived the interactive, group-based aspects of the interventions as a source of social support. Participants described a collaborative learning space that extended into the community, and reported that they maintained friendships post-study.ConclusionThe findings provide support for using societal and cultural knowledge in creating effective community-based interventions. Using a collaborative approach to co-design the program offered participants opportunities to reflect on identity beyond the intervention and in relation to broader community positionality. This study highlights the value of including participants as co-contributors to the development of CRT programs that are linguistically, culturally, and situationally appropriate for LMIC contexts.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT06466642, NCT06466642.

Living with the HIV virus is a chronic health condition with life expectancies among treated people similar to seronegative individuals. However, older people living with HIV (PLWH) are at higher risk for comorbidities, including cognitive impairment, than their seronegative counterparts. Use of memory strategies has been shown to enhance memory performance among older PLWH, yet few studies have examined factors that drive memory strategy use as well as how impairments in metacognition may hinder the initiation of memory strategies. To address this gap, associations between cognitive function, locus of control and memory strategy use among PLWH with and without memory impairment were examined, followed by the association between metacognition and memory strategy use among PLWH. A secondary analysis was performed using cross-sectional data of 174 PLWH aged 40+ years. Spearman’s correlation was used to determine associations between memory strategy use (total, internal, and external), objective cognitive performance (seven domains and global), and locus of control (internal and external), and informed follow-up linear regression models. ANOVA was used to assess differences in memory strategy use between PLWH across metacognition groups (i.e., concordance between subjective and objective memory functioning yielding four groups: agree both normal, agree both impaired, over-estimators, under-estimators). Among PLWH with memory impairment, higher use of total memory strategies was associated with higher SES, White race, and higher external locus of control (powerful others subscale). Higher use of internal memory strategies was associated with higher SES, White race, older age, and higher external locus of control (powerful others and chance subscales). Higher external strategy use was associated with better executive function. Among PLWH without impairment, higher use of total memory strategies was associated with younger age. Higher use of internal memory strategies was associated with poorer global cognition, executive, and learning function. Higher external strategy use was associated with female sex, younger age, and higher SES. Higher internal locus of control was correlated with better function in all cognitive domains among PLWH without memory impairment. Among all PLWH, those who underestimated their cognitive ability used the most memory strategies, while those who overestimated their abilities used the least memory strategies. Those who correctly estimated their cognitive abilities as being normal or impaired fell in the middle with correct estimators of impaired cognition using the second most memory strategies. As PLWH get older, education around the use of effective memory strategies as well as social support to reinforce memory strategy use may be key to promoting improved confidence in cognitive abilities and quality-of-life as cognition declines. PLWH who overestimate their cognitive abilities and people from low socioeconomic status backgrounds may be less likely to use memory strategies and may benefit from being targeted for memory strategy education.

ABSTRACT:Pain in people living with HIV (PWH) is associated with greater psychological distress, poor sleep quality, and functional limitations. Yet the interconnections among these relationships remain understudied. Our study examined whether (a) sleep quality mediates the relationship between pain and depressive symptoms, (b) depressive symptoms mediates the relationship between pain and functional limitations, and (c) pain is associated with functional limitations through a serial pathway. A cross-sectional secondary analysis of 261 PWH was conducted. Pain was assessed using the pain subscale from the Medical Outcomes Study HIV Health Survey; lower scores indicated worse pain. Participants also completed the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression scale, and the Lawton and Brody Instrumental Activity of Daily Living (IADL) scale. Mediation analysis was performed using age, race, and education as covariates. Sleep quality partially mediated the relationship between pain and depressive symptoms, accounting for approximately 42% of the total effect. Depressive symptoms partially mediated the association between pain and IADL impairments (22%), whereas the serial pathway through sleep and depressive symptoms explained 8.4% of pain's total effect on IADL impairments. Improving sleep quality and depressive symptoms may reduce the negative impacts of pain on everyday functioning.

BackgroundDigital cognitive assessments are increasingly used in large-scale studies to assess brain health, offering scalable, standardized, and self-directed testing solutions. Cognitive function remains a concern for people with HIV despite antiretroviral therapy. The BRACE (BrainBaseline Assessment of Cognition and Everyday Functioning) is a validated tablet-based screener for cognition in people with HIV. Preliminary pilot norms were established in a small sample (n=144), but full regression-based normative data have not yet been developed. Consequently, HIV serostatus differences based on standardized BRACE scores and cognitive correlates have not been systematically examined. ObjectiveThis study aims to develop regression-based normative data for BRACE performance in people without HIV who were demographically and behaviorally comparable to people with HIV within biological sex; to examine differences in cognitive performance by HIV status and biological sex; and to evaluate sociodemographic, behavioral, and clinical correlates of BRACE performance. MethodsA total of 2937 participants (1063 people without HIV [499 women] and 1874 people with HIV [1053 women]) in the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study completed BRACE once between November 2020 and March 2025. BRACE includes the Trail Making Test (A and B), Stroop-Color, and visual spatial learning. Regression-based norms were derived from people without HIV using multiple demographic models (eg, age-only, age + education, and age + education + sex). The age + education model was selected for primary analyses because it provided the best balance of interpretability, parsimony, and generalizability while avoiding race-based corrections. HIV serostatus and sex differences were examined using ANOVA and χ2 tests, with effect sizes calculated using Cohen’s d. ResultsCognitive performance was largely comparable between people with HIV and people without HIV across all BRACE outcome measures. Statistically significant differences were very small in magnitude (all effect sizes<0.11) and primarily observed among men on Stroop-Color. Across groups, older age and fewer years of education were associated with poorer raw BRACE performance, although these associations attenuated after demographic adjustment using T-scores. Most clinical and behavioral factors (eg, hypertension, smoking, and noncannabis substance use) were related to poorer raw scores but not standardized performance. However, diabetes and cannabis use remained independently associated with T-scores across multiple measures—diabetes with poorer scores and cannabis use with higher scores, an association that should be interpreted cautiously. HIV-specific clinical factors, such as nadir CD4 count and antiretroviral therapy duration, were linked primarily to raw scores. ConclusionsThis study establishes the first regression-based normative data for BRACE, derived from a large, demographically diverse people without HIV, and demonstrates its applicability for evaluating cognitive function in people with HIV. Findings indicate minimal cognitive differences between people with HIV and people without HIV and highlight the influence of common sociodemographic and metabolic factors. These results support BRACE as a scalable, reliable, and self-administered digital tool for assessing cognitive health in diverse populations and underscore its potential for longitudinal monitoring and precision phenotyping in both research and clinical contexts.

Background/Objectives: Individual plasma protein biomarkers have been shown to correlate with cognitive performance in people with HIV (PWH). This study aimed to investigate the association between plasma proteomic signatures and attention/working memory in virologically well-controlled women with HIV (WWH). Methods: Seventy-seven WWH from three Women’s Interagency HIV Study (WIHS) sites completed neuropsychological (NP) testing and a blood draw. Selected protein biomarkers (200 total) were analyzed using a multiplexing method. Results: Random forest analysis was used to identify the top 10 biomarkers that were each positively or negatively associated with attention/working memory. Ingenuity pathway analysis (IPA) was used to facilitate data interpretation. Tumor necrosis factor receptor 1 (TNF RI), TNF RII, interleukin 1 receptor 1 (IL-1RI), and IL-6R were negatively associated with attention/working memory. Conclusions: Based on the IPA, two gene signaling networks were proposed for associating these plasma protein biomarkers with attention/working memory function. This novel methodology demonstrates how gene networks can be identified using blood draws in conjunction with cognitive assessment, and then used in random forest analysis, to derive value that can be put in IPA.

PURPOSE:Given emerging evidence that healthy dietary interventions are effective long-term strategies for managing chronic pain, this review aimed to define, elucidate, and describe the concept of a healthy diet in the context of chronic pain populations. DESIGN:We used Walker and Avant's concept analysis method. METHOD:PubMed, Embase, CINAHL Plus with full-text, and PsycINFO databases were searched to identify relevant peer-reviewed primary articles on diet and chronic pain, published from June 2013 to June 2024. Key search terms included "diet" AND "chronic pain or pain." RESULTS:Twenty-eight primary articles met our eligibility criteria following full-text reviews. In chronic pain, healthy diet attributes (i.e., nutrient density, anti-inflammation, and anti-oxidation) caused by antecedents (i.e., diet and pain assessments) result in consequences like reduced pain intensity and improved quality of life. Therefore, a healthy diet in chronic pain consists of nutrient-dense foods (fruits, vegetables, healthy fats and low calories) that possess strong anti-inflammatory and antioxidant properties, which are essential for optimizing health, alleviating pain, and enhancing overall quality of life. CONCLUSION:A healthy diet is essential for pain relief and improving the quality of life in individuals with chronic pain. IMPLICATIONS:Healthcare providers should incorporate individualized culturally appropriate dietary preferences, food intolerance, and food allergy alternatives in dietary interventions. Also, there is a need for tailored dietary interventions for individuals living with chronic pain. Future studies should explore mechanisms through which diet affects pain outcomes.

INTRODUCTION:Trauma-related hemorrhage is the leading cause of preventable death in the United States. Current resuscitation guidelines are based largely on data from younger and middle-aged adults, while influencing practice for adults of all ages. We examined age-related differences in blood product administration among individuals predicted to receive massive transfusions for the treatment of trauma-related hemorrhage. METHODS:A secondary analysis was performed using data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial, including 640 critically injured adult patients from 12 level I trauma centers across North America. We included patients aged ≥18 years, with an injury severity score of ≥9, and who had data available for packed red blood cells transfused in the first 24 hours of hospitalization. Patients were categorized based on both injury severity score (moderate, 9-15; severe, 16-24; profound, 25+) and age (young, 18-39; middle aged, 40-59; older, 60+). Descriptive statistics were used to analyze injury severity, mechanism of injury, comorbid conditions, and preinjury medication use. A negative binomial regression was used to evaluate the relationship between the quantity of packed red blood cells administered and age and injury severity categories. RESULTS:Patients (N = 640) were primarily male (80.5%) and white (64.5%) who experienced either blunt (51.7%) or penetrating injuries (47%). Older adults with severe injury severity score were transfused 33% fewer units of packed red blood cells than young adults with severe injury severity score (count ratio, 0.67; 95% CI, 0.47-0.96; P = .031). DISCUSSION:Our findings support a potential difference in the quantity of blood products administered among patients based on age. Further investigation is required to better understand age-related treatment considerations for trauma-related hemorrhage.

Caregivers of stroke survivors in rural communities face geographic isolation with limited access to medical providers, which limits caregiver support and increases caregiver burden. A consolidated synthesis of the domestic and international narrative experiences of rural stroke survivor caregivers would inform interventions. We conducted a systematic search using the PRISMA 2020 framework and guidelines proposed by Bettany-Saltikov and McSherry (2016), focusing on qualitative studies published in PubMed, Embase, and PsycINFO biomedical research databases with no restrictions on location nor publication year. Two independent reviewers assessed studies for original research exploring narrative themes on caregiver burden among rural caregivers, 18 years and older, caring for stroke survivors. Eligible studies followed our indexed search strategy developed in collaboration with a health sciences librarian. Extracted data items included study identifiers, characteristics and main findings (narrative themes). A total of 13 studies representing 161 caregivers, between the ages of 21-85 years old, were eligible for inclusion in this evidence synthesis. Descriptive statistics were used to summarize data items; stratification was applied to organize data into meaningful subgroups. Thematic content analysis and open coding were used to identify patterns and themes. Rural caregivers’ burden was alleviated by community and emotional support from their social networks and care providers but exacerbated by stroke survivor disability severity, unanticipated and rapid role transitions, delays in service initiation, inadequate communication from providers and mistrust in their local health system. Future interventions informed by these data may improve stroke survivors’ quality of life by reducing caregiver burden.

Individual plasma protein biomarkers have been shown to correlate with cognitive performance in people with HIV. This study aimed to investigate the association between plasma proteomic signatures and cognition in virologically well-controlled women with HIV. 77 women with HIV from three Women's Interagency Study (WIHS) sites completed neuropsychological testing and a blood draw. Targeted protein biomarkers were analyzed using a multiplexing method. Random forest analysis was used to identify the top 10 biomarkers that positively or negatively associated with domain-specific or global neuropsychological function. Next, ingenuity pathway analysis was used to facilitate data interpretation. Plasma protein biomarkers are either related to domain-specific or overall cognition: tumor necrosis factor receptor 1 (TNF RI), TNF-RII, interleukin 1 receptor 1 (IL-1RI), and IL-6R are negatively associated with attention/working memory; IL-7 and CD40 are positively associated with executive function; IL-1RI, hepatocyte growth factor (HGF), transforming growth factor beta-1(TGFβ1), TGFβ2, and sonic hedgehog (SHH) are negatively associated but IL-7 is positively associated with fluency; IL-9, IL-15, and IL-21R are positively associated with motor function; Brain-derived neurotrophic factor (BDNF), HGF, SHH, and vascular endothelial growth factor (VEGF) are negatively associated with processing speed. HGF, VEGF, and insulin are negatively associated with global neuropsychological function. Based on the ingenuity pathway analysis, one to three signaling networks were proposed for associating plasma biomarkers with each domain-specific or global neuropsychological function. It is likely that a panel of plasma protein biomarkers can be used to predict domain-specific or global neuropsychological function. Multiple signaling networks might explain cognitive functions in Women with HIV.

BACKGROUND: Women living with HIV (WLHIV) are particularly vulnerable to poor employment outcomes, impacting their socioeconomic independence and personal sense of empowerment. OBJECTIVE: This article presents the results of a mixed methods study, which examined the personal, clinical, and socioeconomic contexts associated with employment and occupational productivity among employed WLHIV (n = 164) in the Southern United States. METHODS: The Stanford Presenteeism Scale-6 was used to assess the perceived impact of HIV disease on the ability to maintain focus and complete tasks at work. Correlational and hierarchical regression techniques were applied to examine the relationships between personal, clinical, and socioeconomic contexts and occupational productivity. RESULTS: In this sample, 62% of women perceived no impact on their ability to work or capacity to complete work related to living with HIV. In multivariable modeling, empowerment, neurocognition, socioeconomic status, and psychological health were associated with occupational productivity. In-depth interviews (n = 29) provided rich contexts and meaning surrounding employment among WLHIV, and indicated that quality of life, work-life balance, empowerment, social support, and psychological health influenced the experience of work. CONCLUSION: Psychosocial and structural interventions are needed to improve occupational outcomes in this vulnerable population.