Abstract
BACKGROUND: Women living with human immunodeficiency virus (HIV) experience significant psychological burdens due to biological and gendered factors such as pregnancy, childbirth and breastfeeding. However, a life course-based understanding of their mental health, adaptation and recovery remains limited. This study aimed to synthesise and analyse qualitative research on the mental health experiences of women living with HIV. METHODS: A qualitative meta-synthesis was conducted following Sandelowski and Barroso's methodology. A comprehensive search of six electronic databases employed keywords and Medical Subject Headings. Eligibility criteria comprised women (population), mental health (concept) and HIV (context). The final studies were selected using the Critical Appraisal Skills Programme (CASP) checklist. Themes and sub-themes were generated through comparison, classification and synthesis of study findings, illustrated by participant quotations. RESULTS: Of 2,793 studies identified, 22 met the eligibility criteria and were appraised using the CASP checklist. These studies were conducted across 15 countries, mostly in Asia, North America and Africa, providing extensive qualitative evidence. Participants included women of reproductive age and older women from diverse ethnic and social contexts. Based on qualitative findings supported by 124 quotations from the included studies, four overarching themes and nine subthemes were identified: (1) post-traumatic stress experienced after an HIV diagnosis, (2) living with HIV and womanhood: the double burden of pain, (3) struggling to endure each day with HIV and (4) yet, the ongoing lived trajectory of becoming. Women described recovery as a non-linear and unstable process marked by recurring cycles of progress and setback. These themes reflect their mental health struggles and adaptation following the existential shock, dual burden and profound suffering that accompany an HIV-positive diagnosis. Despite early emotional distress, women reported relief and empowerment through supportive relationships. CONCLUSIONS: The findings reveal how women living with HIV experience psychological distress and lifelong coping and resilience, across diverse regional, cultural, and healthcare system contexts. These insights can inform healthcare professionals, policymakers, and researchers in developing individualized, sustainable, and adaptive psychosocial care interventions globally. Future research should adopt tailored, lifespan-focused approaches and employ ethnographic methods to complement the potential limitations inherent in qualitative meta-synthesis and deepen understanding of women's lived experiences.