Purpose: To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)-positive, pregnant women in Thailand. Design: Correlational, cross-sectional study. Methods: Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty-seven HIV-positive pregnant women completed questionnaires in Thai on depressive symptoms, self-esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms. Findings: Seventy-eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms (beta = .192, p <.05) were positively associated with depressive symptoms, but self-esteem (beta = -.442, p <.001), emotional support (beta = -.193, p <.01), and financial status (beta = -.209, p <.01) were negatively correlated with depressive symptoms. Conclusions: The study results have added new knowledge about depressive symptoms and their predictors in HIV-positive pregnant women in Thailand. Clinical Relevance: Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV-positive individuals. The high rate of depression in our study suggests that HIV-positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self-esteem should be strengthened for HIV-positive pregnant Thai women.