This retrospective case-control study assessed the psychological burden of abnormal Pap smears, and their prevalence and characteristics among HIV-infected women attending an HIV clinic. Women with positive (n = 73) and negative Pap-smear results (n = 317) were assessed for psychosocial burden using 4 questionnaires: Psycho-Social Impact of Abnormal Pap Smears (PEAPS-Q), Hospital Anxiety and Depression Scale (HADS), Work Productivity and Impairment (WPAI) and the EURO-Qol Thermometer. The prevalence of pre-cervical cancer lesions in HIV infected woman was 17.5% (ASCUS 2.9%, LSIL 3.8%, HSIL 7.4%, SCC 1.7%, and atypical glandular cells including adenocarcinoma 1.7%). HIV infected women with abnormal Pap smears showed higher anxiety levels on the HADS questionnaire (p = 0.015); this had a significant effect on regular daily activities (p = 0.009) per the WPAI questionnaire compared to HIV positive women with normal Pap smear. Ever married HIV infected woman with an abnormal Pap smear had a significantly lower psychosocial burden using the PEAPS-Q questionnaire (p < 0.001). After adjusting for age and duration since last Pap smear, the education level of the patient was a strong predictor for anxiety. Patients, with a college education had significantly lower anxiety (p = 0.001, 95% CI -5.74 to -1.37) than those with lower or higher education. Women with HSIL were more anxious (p = 0.014, 95% CI 0.49 -4.39) than those with low grade or normal lesions.