This article examines discrepancies in how causes of death among women living with HIV are recorded. Substance use and mental illness were among the most common contributors to death, yet were rarely documented on death certificates, while HIV/AIDS was frequently listed as a cause of death even when clinicians determined it played a limited role. The authors argue that improving survival among women with HIV requires greater attention to mental health, substance use, trauma, and other social determinants of health, in addition to HIV treatment and viral suppression.