Peripartum depression among women living with HIV (WLHIV) represents a profound intersection of biological vulnerability, psychosocial adversity, and structural inequity. Emerging global evidence reveals that WLHIV experience higher rates of depressive symptoms during pregnancy and the postpartum period compared to HIV-negative women, a disparity reflecting not only disease burden but also compounded social stressors. This narrative review synthesizes conceptual and empirical insights from studies published between 2020 and 2025 to illuminate the multifactorial nature of peripartum depression within the context of HIV. The literature converges on key determinants HIV-related stigma, intimate partner violence, food insecurity, poverty, and limited social support that collectively heighten susceptibility to psychological distress. Biologically, chronic immune activation and neuroendocrine dysregulation in HIV infection may interact with hormonal changes of pregnancy to increase vulnerability to mood disturbances. The psychosocial and physiological consequences of this comorbidity extend beyond mental health, influencing antiretroviral therapy (ART) adherence, viral suppression, and maternal–infant bonding. Although integrated care approaches are gaining attention, mental health remains underprioritized within perinatal HIV services globally. The review highlights the need for intersectional frameworks that recognize gender-based violence, stigma, and social inequities as central drivers of maternal depression. Integrating routine depression screening, culturally sensitive counselling, and community-based psychosocial interventions into HIV care could mitigate these risks. Ultimately, addressing peripartum depression among WLHIV requires not only biomedical management but also social and structural transformation that affirms the psychological wellbeing and dignity of mothers living with HIV.