The HIV epidemic persists in the province of Ontario, but the demographics of those affected have shifted over time. Over the past decade, the rate of new diagnoses among White Ontarians has decreased, while the rates among certain racialized populations has increased. These increases may be partially due to migration patterns, but a disproportionate burden of HIV transmission may be shifting to specific sub-populations. In a cohort of people living with HIV, a relationship exists between HIV care outcomes and race/ethnicity. In particular, African, Caribbean and Black individuals show lower engagement across the care cascade. Additionally, we find that social factors, such as poverty, and mental health and substance abuse impact engagement in the care cascade and achievement of viral suppression. To prevent HIV transmission and achieve optimal health for people living with HIV, the structural drivers of health inequity must be addressed and people living with HIV must have access to a variety of social, mental health and medical services.