Psychosocial Determinants of Antiretroviral Treatment Adherence among Black Mothers with HIV

Black mothers with HIV (BMWH) face treatment adherence (TA) challenges, shaped by gendered anti-Black racism, oppression, and structural inequalities, which hinder healthcare access, support, and well-being. Compounded by mothering responsibilities, understanding the determinants of TA is critical to addressing their unmet needs. We utilized an explanatory cross-sectional, multiphase sampling survey design. Twenty-five BMWH completed a 30-min online survey assessing their demographics, TA, and determinants. Spearman's correlation coefficient assessed associations between psychosocial and structural determinants and TA. Mann-Whitney U-tests explored group differences by TA status (< 85%; ≥ 85%). BMWH were middle-aged (M = 42, SD = 13.77), single (64%), low-income (60%), long-term survivors (M = 15, SD = 9.72), and treatment adherent (85.36%). HIV-related resilience was associated with increased TA (r s = .46, p = .05), while perceived stress was associated with reduced TA (r s = −.46, p = .05). Statistically significant differences were found in depression and perceived stress scores by adherence status. Sub-optimally adherent BMWH reported greater perceived stressors ( Mdn = 174.5), and higher depression ( Mdn = 167). Findings suggest that stress and mental health symptoms contribute to suboptimal TA. Multilevel interventions are needed to address maternal distress and improve HIV treatment outcomes among BMWH.