Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 26, 2025
Date Accepted: Feb 25, 2026
Stigma, Food Insecurity, and Social Support Among Pregnant Women Living with HIV in Uganda: A Cross-Sectional Study of Psychosocial Correlates of ART Adherence
ABSTRACT
Background:
Background:
Adherence to antiretroviral therapy (ART) during pregnancy is critical for maternal health and the prevention of vertical HIV transmission. In Uganda, where HIV prevalence remains high, pregnant women living with HIV (WLWH) face intersecting structural and psychosocial challenges, including stigma, food insecurity, and limited social support. Although each factor has been linked to ART nonadherence, less is known about their co-occurrence and combined influence during the perinatal period.
Objective:
Objective:
This study used latent profile analysis (LPA) to identify psychosocial vulnerability profiles among pregnant WLWH in Uganda and examined their associations with ART adherence.
Methods:
Methods:
We conducted a cross-sectional analysis of 167 pregnant WLWH recruited from six health facilities in Uganda between June and December 2020. Measures included experienced HIV stigma, internalized HIV stigma, household food insecurity, and interpersonal social support. LPA identified psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for sociodemographic covariates.
Results:
Results:
A 2-class solution provided the best model fit. The higher-risk profile (45.1%) was characterized by elevated experienced stigma (M=1.97), higher internalized stigma (M=2.66), severe food insecurity (M=7.53), and lower social support (M=2.06). The lower-risk profile (54.9%) showed significantly lower stigma, minimal food insecurity (M=0.82), and slightly higher social support (M=2.14). Membership in the higher-risk profile was associated with significantly lower ART adherence compared to the lower-risk profile (β=0.43, p=.023). Marital status also predicted adherence; widowed women reported lower adherence compared to unmarried participants (β=−3.40, p=.019).
Conclusions:
Distinct psychosocial profiles are strongly associated with ART adherence among pregnant WLWH in Uganda. Findings underscore the need for multicomponent interventions that simultaneously address stigma, food insecurity, and limited social support. Integrating peer support, community-based ART delivery, and nutritional assistance may strengthen maternal adherence and accelerate progress toward Uganda’s 95-95-95 targets. Person-centered approaches such as LPA provide valuable insights for tailoring interventions to the needs of high-risk subgroups.
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