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Young people living with HIV (YPLH) in Ghana aged 10-24 face elevated barriers to effective HIV management due to structural, social, and economic challenges. These barriers, including poverty, social stigma, gendered inequities, and limited social and household support, disrupt medication adherence and access to healthcare. Inadequate adherence contributes to increased viral loads, reduced HIV knowledge and acceptance, and ongoing transmission. Despite this vulnerability, the lived experiences of YPLH in Ghana and the strategies they use to navigate these barriers remain underexplored. Using a qualitative design, semi-structured interviews were conducted with young people (n = 18) aged 16-25, and data were analyzed using inductive thematic analysis to identify key barriers and coping strategies. Findings reveal that barriers to HIV management are embedded in daily life and shaped by psychosocial, financial, and gendered constraints. Women experienced more frequent and compounded barriers than men, particularly related to stigma, domestic expectations, and economic dependence. Across participants, challenges related to mental and physical health, financial insecurity, stigma, and time demands disrupted engagement with care. Despite these challenges, participants demonstrated resilience and agency, describing adaptive strategies such as reliance on peer and community resources, selective disclosure, and creative approaches to managing medication. These findings highlight the persistent barriers faced by YPLH and their capacity to develop resourceful, peer-informed strategies. Centering lived experiences and coping practices, this study emphasizes the importance of HIV care approaches that strengthen personal skills, foster socially supportive care environments, and address broader structural determinants through gender-responsive, multisectoral programming beyond clinical settings.