Study: Stigma May Lead to Cognitive Impairment in Men with HIV

Understanding how HIV-related stigma can affect patients later in life can lead to new approaches to address cognitive impairment in this population.

For men living with HIV, stigma associated with the disease may be directly related to cognitive impairment and everyday functioning, according to a new study published in the Journal of Acquired Immune Deficiency Syndromes.

As individuals infected with HIV are now living longer, the related psychological and social burden of the disease has grown. Not only can stigma prevent individuals from seeking care, but it can have damaging effects on patients’ mental health and potentially contribute to declining cognitive function, according to the researchers.

For the study, the authors compared results from cognitive testing and mental health questionnaires with stigma-related questionnaires from 512 older men with HIV. HIV-related stigma, as indicated by a single self-report item, was found to contribute to lower cognitive test performance and worse mental health.

The link between HIV-related stigma and on cognitive test performance and anxiety was more predominant, whereas stigma had a direct but weaker association with depression. As a result, the researchers noted that stigma contributed to a downstream effect on participation in social activities and function in everyday life. Although the mechanisms through which stigma affects cognition are unclear, the researchers noted that the impact of chronic stress on the brain and psychological effects, such as internalized negative beliefs, may be factors.

“Our research shows that the neurological impact of HIV goes beyond pure biology,” senior study author Lesley Fellows, MD, PhD, a researcher at The Neuro, said in a press release about the findings. “The psychological and social environment in which the patient lives also plays a role. This study underscores the need for interventions that reduce social stigma and support resilience against its toxic effects on brain health.”

A previous systematic review by the CDC examined stigmatizing factors among health care providers that may impede a patient’s care. In the review, the authors suggested that provider-centric stigma reduction interventions can help reduce stigmatizing behaviors toward patients with HIV, ultimately improving care. They noted that increased provider education and awareness and policies such as opt-out HIV testing, can help normalize testing.

Understanding how stigma can affect patients later in life can lead to new approaches to addressing related health issues, such as cognitive impairment, in this population. With these findings, the researchers concluded that the study provides evidence that HIV-related stigma is a threat to cognitive, as well mental health, with a potential negative effect on everyday functioning in men with HIV.

References

Lam A, Mayo NE, Scott S, et al. HIV-related stigma affects cognition in older men living with HIV. Journal of Acquired Immune Deficiency Syndromes. 2018. Doi: 10.1097/QAI.0000000000001898

Stigma impairs cognition in men living with HIV [news release]. https://www.mcgill.ca/neuro/channels/news/stigma-impairs-cognition-men-living-hiv-292057. Accessed November 27, 2018.