Associations Between Internalized HIV Stigma and Cognitive Function Among Older Women With HIV

Abstract

Objectives: Internalized HIV stigma refers to the negative beliefs, feelings, and attitudes that people with HIV (PWH) adopt about themselves due to societal HIV stigma. Internalized HIV stigma negatively affects mental health but less is known about this factor on cognitive function in PWH. This study examines associations between internalized HIV stigma and cognition among women aged 50+ with HIV.

Methods: Internalized HIV stigma was measured in the Women's Interagency HIV Study between 2013 and 2015 using the HIV stigma scale (negative self-image subscale). Executive function, processing speed, attention/working memory, verbal learning, verbal memory, verbal fluency, and fine motor function were assessed using a validated cognitive battery. Demographically adjusted T-scores were calculated for each domain (higher scores = better performance). A global cognition score was computed by averaging the domain-specific scores. Linear regression models adjusted for age, race, ethnicity, cognition at baseline, average annual income, undetectable viral load, smoking history, recent nonprescription drug use, menopausal status, depressive symptoms, and alcohol use.

Results: Participants' (N = 760) mean age was 54 years; 61% identified as Black/African American; 13% were Hispanic; and 54% had an annual income below $12,000. The median time between the first and second cognitive assessments was 4 years. Higher internalized HIV stigma was associated with poorer global cognitive function, verbal learning, and verbal memory at time 2.

Discussion: Findings suggest assessing and monitoring HIV stigma may benefit cognitive function for older women aging with HIV by identifying those at greater risk for cognitive decline who could be targeted for stigma reduction interventions.

Keywords: Cognition; HIV/AIDs; Social determinants of health.