Women with HIV (WWH) often receive suboptimal screening for cervical cancer despite being at an increased risk for cervical cancer and poor viral suppression. Mental health symptoms and substance use can adversely influence cervical cancer screening and viral suppression. The subjective experience of how these variables influence these outcomes in reproductive-age WWH is not well understood. Our study explored the perspectives of reproductive-age WWH living in Florida regarding the mechanisms by which mental health or substance abuse influences cervical cancer screening and viral suppression. An explanatory sequential mixed methods research design was used. A one-on-one semi-structured interview guided and informed by the Social Ecological Model (SEM) and results from previous quantitative analysis were used (N =16). Themes related to how substance use and mental health symptoms as barriers, and facilitators, including motherhood, community support, marijuana use, and medication adherence were reported. Study finding implications for research and clinicians are discussed.