OBJECTIVES: This study was conducted in order to determine whether food insecurity is associated with poor mental health outcomes among PLHIV in Togo and Côte d'Ivoire, West Africa. DESIGN: Cross-sectional study among participants enrolled in the International epidemiological Databases to Evaluate AIDS West Africa cohort. METHODS: The Household Food Insecurity Access Scale was used to measure food insecurity. The PHQ-9, GAD-7, PCL-5, and AUDIT-C instruments were used to assess depressive symptoms, anxiety symptoms, symptoms of post-traumatic stress disorder (PTSD), and harmful alcohol use, respectively. Logistic regression was used to identify factors associated with poor mental health outcomes. RESULTS: Among 584 participants (68.8% female, median age 52 years), nearly half (48.1%) were food insecure; 7.0% were mildly food insecure, 26.7% were moderately food insecure, and 14.4% were severely food insecure. Severe food insecurity [OR 2.63 (1.30-5.34)] and being widowed [OR 2.15 (1.07-4.30)] were associated with moderate-to-severe depressive symptoms and formal education was protective [OR 0.30 (0.15-0.61)]; there was a trend towards an association between severe food insecurity and moderate-to-severe anxiety symptoms [OR 2.14 (0.98-4.70)] and formal education was protective [OR 0.35 (0.18-0.71)]; severe food insecurity [OR 6.87 (2.89-16.38)] and being widowed [OR 3.55 (1.46-8.59)] were associated with PTSD; mild food insecurity [OR 2.74 (1.20-6.26)] and male sex [OR 11.58 (5.44-24.68)] were associated with high risk alcohol use. CONCLUSIONS: Food insecurity is associated with poor mental health outcomes among PLHIV in Togo and Côte d'Ivoire, West Africa. Future studies to understand and address the causal links between food insecurity and mental health among PLHIV are warranted.< Réduire