HIV-Related Stigma in People Living with HIV: A Cross-Sectional Analysis of a Portuguese Clinical Cohort

HIV-related stigma remains a barrier to well-being and long-term care despite effective antiretroviral therapy. We conducted a cross-sectional analysis using baseline data from a prospective real-world cohort of adults receiving routine HIV care in northern Portugal. Overall HIV stigma was the primary outcome, and associations with sociodemographic, clinical, laboratory, behavioral, and patient-reported variables were examined using univariable and multivariable linear regression. Among 467 participants, the median overall stigma score was 30 (Q1-Q3, 26-35), and disclosure concerns had the highest median subscale score. The multivariable model was statistically significant, F(7,429) = 10.254, p < 0.001, adjusted R² = 0.129. Higher overall stigma was independently associated with HIV-1 viral load ≥ 200 copies/mL (B = 4.489, 95% CI 0.660 to 8.318, t = 2.304, p = 0.022), anxiety symptoms (B = 0.318 per point, 95% CI 0.120 to 0.515, t = 3.166, p = 0.002), and depressive symptoms (B = 0.236 per point, 95% CI 0.031 to 0.441, t = 2.259, p = 0.024). A history of opportunistic infection was associated with lower stigma (B = -1.826, 95% CI -3.524 to -0.128, t = -2.114, p = 0.035). Higher quality-of-life scores were consistently associated with lower stigma (t values ranging from - 10.690 to -4.161, all p < 0.001). These findings support routine stigma-sensitive and psychologically informed HIV care to identify psychosocial needs and potentially improve well-being and treatment outcomes.