HIV-related stigma and its association with CD4 counts and virological control among people living with HIV in Peru: a cross-sectional study

HIV-related stigma remains a significant challenge for people living with HIV (PLWH), particularly in developing countries such as Peru, where access to healthcare may be limited. This study examined how external stigma, including disclosure concerns, public attitudes and internal stigma, such as negative self-image affect social disparities, mental health, and clinical outcomes in PLWH. A cross-sectional study was conducted with 407 adults undergoing antiretroviral therapy in a Peruvian hospital between March and May 2017. Participants completed surveys assessing stigma, depression, anxiety, quality of life, and adherence to treatment, while clinical data including CD4 counts, and cognitive function were also collected. Nearly 90% of participants reported experiencing some form of stigma, and more than 70% screened positive for depression. Negative self-image was significantly associated with poorer virological control whereas established stigma was linked to lower CD4+ counts. Cognitive deterioration was observed in almost one-fifth of patients. Overall, stigma was strongly linked to impaired mental health, reduced quality of life and worse immunologic outcomes. These findings highlight the importance of addressing stigma within HIV care, as targeted interventions may improve treatment adherence with further virological control, and the overall well-being of PLWH.