Abstract
Internalized HIV-related stigma undermines mental health, quality of life, and engagement in care among people living with HIV (PLHIV), yet data from Vietnam remain limited. We analyzed data from the 2020 PLHIV Stigma Index, a cross-sectional study conducted in seven provinces. Participants were recruited primarily from public outpatient HIV treatment clinics and through limited chain referral. Internalized stigma was assessed using the 6-item Internalized AIDS-Related Stigma Scale (IARSS); scores of 5-6 were classified as high internalized stigma. Among 1,623 participants (mean age 34.6 years, 74.6% male), the IARSS showed acceptable internal consistency (Cronbach's alpha = 0.74), and 29.4% had high internalized stigma. In the multivariable logistic regression, secondary/high school education (adjusted odds ratio [aOR]: 0.47, 95% confidence interval [CI]: 0.35-0.65), university/tertiary education (aOR: 0.34, 95% CI: 0.22-0.52), and more than 5 years since HIV diagnosis (aOR: 0.66, 95% CI: 0.49-0.89) were associated with lower odds of high internalized stigma. Higher odds were observed among participants with depression/anxiety symptoms (aOR: 2.02, 95% CI 1.56-2.62), those unaware of their partner's HIV status (aOR: 1.79, 95% CI 1.21-2.65), and those reporting community stigma or discrimination in the prior 12 months (aOR: 1.49, 95% CI 1.06-2.09); internalized stigma also varied by province. Internalized stigma remains common among PLHIV in Vietnam and appears shaped by psychological, relational, community, and geographic factors. Integrated mental health, stigma-reduction, and context-responsive interventions may help reduce internalized stigma.