Experienced and anticipated HIV-related stigma and depression among pregnant and postpartum women living with HIV in the Greater Accra Region of Ghana: the role of internalized HIV stigma

BACKGROUND: Postpartum women living with HIV (WLWH) in sub-Saharan Africa face intersecting structural, psychological, and social challenges. HIV-related stigma, including experienced, anticipated, and internalized dimensions, has been linked to poor mental health outcomes. However, little is known about how these distinct stigma mechanisms interact to influence depression in Ghanaian WLWH. This study aimed to examine whether internalized stigma mediates the relationship between experienced or anticipated HIV stigma and depressive symptoms among pregnant and postpartum WLWH in Ghana. METHODS: This study used cross-sectional data from 176 postpartum WLWH receiving care at 11 public health facilities in Greater Accra, Ghana, between March and May 2022. Participants completed validated measures of experienced, anticipated, and internalized HIV stigma, as well as depressive symptoms. Descriptive statistics were computed, and two mediation models were tested to assess whether internalized stigma mediated the associations between experienced or anticipated stigma and depressive symptoms. RESULTS: The mean age of participants was 31.91 years (SD = 5.12), and the mean depression score was 17.41 (SD = 3.56). In the first mediation model, experienced stigma was not directly associated with depression (B = 0.20, p = .360) but showed a significant indirect effect via internalized stigma (B = 0.31, 95% CI 0.151, 0.520). Similarly, anticipated stigma had no significant direct effect (B = 0.47, p = .103) but also demonstrated a significant indirect effect through internalized stigma (B = 0.32, 95% CI 0.122, 0.557). CONCLUSION: Internalized HIV stigma significantly mediates the effects of both experienced and anticipated stigma on depressive symptoms in postpartum WLWH in Ghana. These findings highlight internalized stigma as a key psychological mechanism linking social adversity to poor mental health in this population. Integrating stigma-reduction strategies and targeted mental health support into postnatal HIV care may be critical for improving psychological and physical health outcomes among postpartum WLWH in resource-limited settings.