Graduation Year

2025

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Anthropology

Major Professor

Heide Castañeda, Ph.D.

Committee Member

Daniel Lende, Ph.D.

Committee Member

Nancy Romero-Daza, Ph.D.

Committee Member

Ambar Basu, Ph.D.

Committee Member

Jason Wilson, MD, Ph.D.

Keywords

Medical anthropology, belonging, treatment adherence

Abstract

Despite significant global advancements in HIV care, engagement in continuous HIV care remains a challenge, particularly for individuals living with comorbid HIV and mental health disorders. This dissertation examines the barriers to continuous HIV care for those individuals living with comorbid HIV and depression and/or anxiety in the Tampa Bay area. This dissertation argues that dual health challenges are dually challenging. This study highlights how structural vulnerabilities, how feelings of inclusion and exclusion impact engagement in care, and socioeconomic challenges intersect to shape patient experiences and impact adherence to treatment. Drawing on critical medical anthropology, structural violence, embodied belonging, and the social determinants of health, this research uses both qualitative and quantitative methods, such as the Structural Vulnerability Assessment Tool (SVAT), semi-structured interviews, and participant observation, to explore the barriers that individuals living with comorbid HIV and mental health disorders face in their daily lives as well as navigating the healthcare system while managing dual health challenges. Research findings reveal that stigma (both self, interpersonal, and societal), economic challenges, and institutional barriers significantly impact engagement in HIV care. By integrating qualitative ethnographic methods with a quantitative analysis of structured vulnerabilities, this dissertation highlights the lived experiences of those living with HIV and depression and/or anxiety. This research challenges biomedical models of comorbidity that often prioritizes HIV treatment over mental health care. This dissertation argues for interventions, such as increased funding for mental health resources in HIV care and integrated care models. This research contributes to both anthropological scholarship and public health policy, emphasizing the need to address the structural and social determinants for individuals living with HIV and comorbid mental health disorders, such as depression and/or anxiety.

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