This cross-sectional study sought to: ”Determine the association between stress, depression and ART adherence among women living with and accessing care for HIV in Toronto, Ontario, between 2007 and 2012h. Using OCS data, logistic regression models were used to identify covariates of (≥95%) adequate adherence and mediators and moderators in the association between stress and adherence. Among 307 women, 34.5% and 65.5% had poor and adequate adherence, respectively. Women with poor versus adequate adherence had more reports of hazardous alcohol use, stress events and depressive symptoms. No hazardous alcohol use (aOR=2.20, 95%CI:1.12- 4.32) and fewer stress events (aOR=0.56, 95%CI:0.33-0.94) were associated with increased odds of adequate adherence. The association between environmental stress and adequate adherence was attenuated among women ≤35 years (aOR=0.73, 95%CI:0.56-0.94) versus ≥45 years (aOR=0.51, 95%CI:0.34-0.77). Interventions to improve adherence and ensure levels ≥95% must address stress and promote adaptive coping strategies to reduce or eliminate hazardous alcohol use.