Health literacy is emerging as a key element for successful medication management and empirical support for the efficacy of numeracy in the health context is rising as well. Little is known, however, about their unique effects among women and men. Given the importance of accurate medication management for effective treatment of HIV, the relation of these variables to medication management needs to be assessed. We therefore tested the relation of health literacy (reading comprehension) and numeracy to one's ability to manage a "mock" HIV regimen and whether men and women differed in these abilities. Results showed that women were less able than men to follow medication instructions and answer questions about the mock regimen. Numeracy mediated the relationship between gender and medication management. These findings highlight skills used in managing medication regimens and suggest avenues to target for identification and intervention in medication management among women and men with HIV.

About one-third of HIV-infected people in the USA have a history of injection-drug use. Injecting drugs are a primary vector for HIV transmission. Drug and alcohol use are significant contributors to sexual transmission of the virus. In South Florida, urban injection-drug users (IDUs) represent a substantial population at risk for infection. Substance use management in this group is critical. As part of a larger study of at-risk populations in South Florida, we examined mental health differences among IDUs (n = 117), HIV seropositive IDUs (n = 130), and HIV seronegative non-IDUs (n = 169). We explored factors associated with depression and anxiety between groups, and found HIV seronegative and seropositive IDUs not receiving antiretroviral (ARV) treatment to have poorer overall mental health than both HIV seropositive participants on ARVs and non-IDU participants. Our data support systems enhancement to meet the various psychosocial and health care needs among IDUs and highlight the need for resource allocation to target community-based integrated mental health services in urban populations. In addition, our data underscore the need for primary and secondary HIV prevention interventions to address the drug-use risk behaviors among IDUs to reduce the likelihood of HIV infection and transmission in this population.

Abstract:The cortisol response is an important measure of the endocrine activity to environmental challenges and has been related to cognitive function and mood. Previous studies have shown that the cortisol response to stress is dysregulated in persons with HIV-1 infection. Since cortisol is neurotoxic and its levels have been related to cognitive dysfunction in various disorders, it is possible that neuroendocrine dysregulation may also be related to cognitive dysfunction in individuals with HIV-1 infection. The purpose of this study was to test the hypothesis that the cortisol response to an alpha adrenergic challenge, cold pressor, is related to cognitive function in HIV-infected injecting drug abusers. We used growth curve modeling to study the relationship of cold pressor challenge stimulated cortisol response to scores on the modified HIV Dementia Scale (mHDS). To test this hypothesis, we assessed the effects of HIV-1 infection on the HDS score directly and indirectly via pattern of cortisol response. The analysis showed that HIV-1 infection was directly related to mHDS performance and that it also influenced scores on the mHDS by way of individuals' pattern of cortisol response. Cortisol response to -adrenergic challenge thus may mediate cognitive deficits in individuals with HIV-1 infection. These findings further emphasize the importance of understanding the role of stress in the cognitive problems associated with HIV-1 infection.