HIV-Related Stigma and Its Impact Across the HIV Care Continuum: Implications for Testing, Treatment, and Long-Term Retention.

While major medical breakthroughs have made human immunodeficiency virus (HIV) a manageable chronic illness, stigma related to HIV continues to create significant obstacles for prevention efforts, testing programs, treatment access, and ongoing patient care. This stigma affects people at personal, social, healthcare, and system-wide levels, preventing progress toward international HIV control objectives, particularly the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, which aim for 95% of people living with HIV to know their HIV status, 95% of those diagnosed to receive sustained antiretroviral therapy (ART), and 95% of those receiving ART to achieve viral suppression. The objective of this article is to examine different types, mechanisms, and consequences of HIV-related stigma and its impact across the HIV care continuum, including from initial testing to treatment initiation and sustained retention in care. This comprehensive review examines current research on HIV-related stigma, drawing from theoretical models, population studies, and systematic analyses, with particular focus on sub-Saharan Africa (SSA) and Tanzania. Enacted, anticipated, internalized, and structural stigma were analyzed in relation to HIV testing participation, the initiation of antiretroviral therapy (ART), continued care engagement, and long-term health outcomes. Results showed that stigma surrounding HIV substantially decreases testing participation because people fear having their status revealed, facing discrimination, and being socially rejected. Following diagnosis, stigma leads to delays in starting ART, poor medication compliance, treatment gaps, and withdrawal from medical care. Self-directed stigma strongly correlates with depression and diminished confidence in managing one's health, while discrimination in healthcare environments and institutional barriers damage relationships between patients and providers. Vulnerable groups face multiple forms of stigma simultaneously, which worsens disparities in care participation and viral control. Research shows that comprehensive interventions targeting multiple levels effectively reduce stigma and enhance health outcomes. HIV-related stigma continues to be a major public health challenge that undermines individual health outcomes, contributes to ongoing HIV transmission, increases healthcare utilization and costs, reduces workforce productivity, and impedes progress toward public health and economic goals. Tackling stigma through well-coordinated, multifaceted interventions is critical for increasing testing rates, encouraging treatment initiation, maintaining long-term patient engagement, and achieving lasting viral suppression to control the epidemic overall.