Resumen

Background : The “fourth 90” assessment of people with HIV (PHIV) is recommended in international guidelines, but it is no defined who and how is the best way to implement in routine care. The aim of this study is to describe the main findings after a standardized assessment of stigma in PHIV. Methods : Retrospective observational study of the results obtained after an assessment of stigma using a validated 30-item HIV-stigma questionnaire (four-point Likert-type scale) in PHIV attended in a tertiary hospital. As part of routine care, 2,270 PHIV were invited to complete (online) the questionnaire from 2019 to 2024, through an application of the center itself, integrated into the electronic medical record. A multivariate analysis was performed to assess the four dimensions of stigma: personalized stigma, concerns about disclosure, negative self-image, and concerns regarding public attitudes. Results : 1,296 PHIV completed the questionnaire, most of them were men (1,261 – 97%) with a mean age of 46.7 ± 10.4 years (range 25 – 81); 34.4% of them were > 50 years old. The highest degree of stigma was observed in relation to concerns about disclosure and concerns about public attitudes (table 1), with scores on several items ranging from 70% to 90%. In these stigma domains, we could observe statistically significant differences between PHIV >50 years old versus people <=50 years old on several concerns (losing their jobs when employers learn that they have HIV, telling someone about they have HIV is risky, worry that people may judge them when they learn about their HIV status). Regarding personalized stigma and negative self-image, several items have rates ranging from 20 to 46%. In these domains we also see significant differences between PHIV >50 years old versus people <=50 years old (feeling guilty or feeling as if their body were dirty because they have HIV, feeling hurt by how people react to learning I have HIV). Conclusions : Assessing stigma in routine follow-up can be a useful strategy to measure the needs of PHIV and determine how concerns about disclosure and public attitudes are the main concerns of PHIV. Its implementation through digital tools can facilitate its use, although it requires strategies to achieve results in underrepresented groups such as women or older adults.