An empirical cut-off for the Brief Berger HIV Stigma Scale to identify psychosocial vulnerability in people living with HIV in Nigeria: A cross-sectional study

This study addresses a key challenge in HIV care: the lack of a validated screening tool for psychosocial vulnerability. Although the Berger HIV Stigma Scale is widely used, no clear threshold exists to identify individuals at high risk for mental health problems. Our research aimed to establish a practical, data-driven cut-off score for the scale in a Nigerian context and to explore which dimensions of stigma are most linked to psychosocial vulnerability. We conducted a cross-sectional study with 285 people living with HIV (PLHIV) at three tertiary healthcare facilities in Lagos, Nigeria, using random sampling. Psychosocial vulnerability was defined as having moderate-to-severe depression (PHQ-9 ≥10) or anxiety (GAD-7 ≥10). We used the 12-item Brief Berger HIV Stigma Scale and checked its reliability. A Receiver Operating Characteristic (ROC) curve analysis was used to find the best cut-off score for predicting vulnerability, and logistic regression was used to identify factors that independently predicted this outcome. The Brief Berger HIV Stigma Scale showed strong internal consistency (Cronbach’s alpha = 0.87). A cut-off score of 29.5 was found to be an effective predictor of psychosocial vulnerability, with a sensitivity of 87.5% and an AUC of 0.717. In the regression analysis, concerns about public attitudes were the strongest predictor of vulnerability (OR = 1.6; 95% CI: 1.2–2.0; p < 0.001). We also found a marginal link to negative self-image (OR = 1.4; p = 0.054) and that women were more vulnerable than men. This study provides a practical, evidence-based cut-off score for screening psychosocial risk among PLHIV in Nigeria. Our findings show that public attitudes are a primary source of distress, underscoring the need for public health efforts that address societal stigma. These results support a more integrated approach to HIV care that includes mental health screening and addresses specific drivers of vulnerability like gender disparitie