Health factors, stigma, and psychosocial resources associated with self-rated health: a cross-sectional analysis of the People Living with HIV Stigma Index 2.0 in Bolivia

Background: As HIV has become an increasingly manageable health condition, improving quality of life for people living with HIV has been recognized as central to an effective HIV response. Self-rated health is a widely used, validated indicator of overall health and quality of life, yet factors shaping self-rated health among people living with HIV in Bolivia and across Latin America remain understudied. Methods: We analyzed data (n = 900) from the People Living with HIV Stigma Index in Bolivia conducted between June and December 2022. Multivariate logistic regression was used to assess how sociodemographic characteristics, health factors, stigma, and psychosocial resources were associated with self-rated health. Findings: Participants were an average of 35 years of age and identified as cisgender men (61%, n = 546), cisgender women (34%, n = 303), or transgender/non-binary (6%, n = 51). Fewer than half of participants rated their health as good (n = 384, 43%). In multivariate models, higher educational attainment (OR: 1.71; 95% CI: 1.10, 2.65), being virally suppressed (OR: 1.78; 95% CI: 1.14, 2.78), and greater HIV resilience (OR: 1.91; 95% CI: 1.39, 2.64) were significantly associated with increased odds of good self-rated health. Conversely, having comorbid health conditions (OR: 0.57; 95% CI: 0.43, 0.77) and greater internalized stigma (OR: 0.83; 95% CI: 0.76, 0.90) were associated with lower odds of good self-rated health. Interpretation: In addition to ensuring viral suppression, HIV programs and clinics must prioritize screening for and addressing comorbidities including cooccurring infections, mental health conditions, and noncommunicable diseases within environments free of stigma. Addressing internalized stigma and strengthening HIV-specific resilience may be critical for improving quality of life and supporting sustained engagement in HIV treatment and long-term well-being. Funding: This study was funded by the National Institute of Mental Health including R01MH140784 and the Center for HIV and Mental Health Stigma Elimination Strategies (CHIMES, P30MH136919), the National Institute of Allergy and Infectious Diseases (R01AI170249), the Global Fund country grant and regional project of the Alianza en Positivo (ALEP), the Bolivian Ministry of Health, and UNAIDS. KR was supported by the National Institute of Mental Health (K01MH129226). The funders had no role in the study design; collection, analysis, or interpretation of data; writing of the report; or in the decision to submit the paper for publication.