Internalized HIV Stigma, Depressive Symptoms, and Antiretroviral Therapy Adherence Among Pregnant and Postpartum Women With HIV in Ghana: A Cross‐Sectional Study

ABSTRACT Background and Aims Pregnancy and the postpartum period can present substantial psychosocial and HIV‐care challenges for women living with HIV (WLWH), with potential consequences for psychological well‐being, treatment engagement, and maternal and infant health. This study examined whether internalized HIV stigma mediates the relationship between depressive symptoms and antiretroviral therapy (ART) adherence among pregnant and postpartum WLWH in Ghana. Methods Structured interviews were administered during antenatal and postnatal care visits in private settings to 176 women receiving ART at 11 public health facilities in the Greater Accra Region. Validated measures were used to assess depressive symptoms, internalized HIV stigma, and self‐reported ART adherence. We tested a simple mediation model with bootstrapped confidence intervals to evaluate the indirect association between depressive symptoms and ART adherence through internalized HIV stigma, adjusting for age. Results Approximately one‐third (35.8%) of participants reported below‐average ART adherence. Greater depressive symptom severity was associated with higher internalized HIV stigma, which was associated with poorer adherence. Although depressive symptoms were not directly associated with nonadherence, a statistically significant indirect association was observed through internalized stigma, consistent with an indirect‐only mediation pattern. Age was not significantly associated with either stigma or adherence. Conclusion Our findings suggest that internalized HIV stigma may help explain the association between depressive symptoms and reduced ART adherence among pregnant and postpartum WLWH in Ghana. The results support consideration of integrated approaches that address both mental health and stigma within maternal HIV care. Scalable models, including group‐based therapy delivered by lay health workers, may offer opportunities to support ART adherence and well‐being in resource‐limited settings. These findings contribute to our understanding of how psychosocial factors may shape treatment engagement among WLWH and identify potential targets for future intervention research.