HIV-Related Stigma Assessment Through an Integrated Digital Strategy in Routine Clinical Care

Abstract

Despite major advances in antiretroviral therapy and increased public awareness of HIV transmission routes, people with HIV continue to experience HIV-related stigma, which has been associated with adverse psychosocial outcomes and challenges in health care engagement. This study aimed to assess HIV-related stigma across four dimensions, using Berger’s HIV Stigma Scale. An observational study was conducted at a tertiary hospital in Spain, where adults living with HIV were invited between 2019 and 2024 to complete a validated version of Berger’s stigma scale through an online tool integrated into the electronic medical records system. Stigma dimensions were analyzed overall and compared by age group (≤50 vs. >50 years). The final cohort included 1296 participants, predominantly male (97.3%). The median age was 46 years; 20.5% had previously accessed mental health services. A high burden of stigma was observed across all dimensions, with concerns related to disclosure emerging as the most prevalent: 91.8% of participants reported being very cautious about disclosing their HIV status, and 88.3% concealed their diagnosis in many aspects of their lives. Concerns about public attitudes were also frequent. Participants aged ≤50 years showed higher levels of internalized stigma, particularly negative self-image and personalized stigma. These findings highlight the persistence of HIV-related stigma in routine clinical settings and reinforce the value of its systematic assessment to identify psychosocial vulnerability and inform person-centered care; however, they should be interpreted in light of the observational design, as causal relationships with clinical outcomes cannot be established.