Introduction:
Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) have been known as a stigmatizing illness. HIV/AIDS-related stigma, in its severe form, compromises the well-being of persons living with HIV/AIDS (PLWHA).

Aim:
To identify the factors associated with severe stigma among PLWHA in Port Harcourt.

Material and methods:
This was a hospital-based cross sectional study involving PLWHA attending anti-retroviral clinic of the University of Port Harcourt Teaching Hospital (UPTH) in Port Harcourt. Data on sociodemographic characteristics and stigma were obtained from 302 participants selected by systematic random sampling. Bivariate and multivariate analyses were performed to explore factors associated with severe stigma among PLWHA.

Results:
Eighty-seven of the 302 respondents (28.8%) had severe stigma. PLWHA who were males, non-Christians, who had no formal education, and had no source of income had the highest proportion of severe stigma. Multivariate analysis revealed that source of income was a predictor for severe stigma among PLWHA (odds ratio 3.59; CI95% 1.45–8.90; P = 0.006).

Discussion:
The findings in this study expose the negative influence of lack of income on the psychological being of PLWHA as those who had no source of income were more likely to experience severe stigma than those with a source of income.

Conclusions:
Severe stigma is prevalent among PLWHA in Port Harcourt. The need for stigma prevention strategies among PLWHA is advocated especially among those with no source of income. Financial empowerment and creation of employment opportunities by Nigerian government in collaboration with non-governmental organizations could mitigate stigma among PLWHA.