Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life

Abstract

Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.

The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV

“…Two studies revealed that HIV-related stigma is a significant predictor of poor performance on cognitive tests and may have long-lasting effects on brain function, especially executive function ( 39 , 40 ). Moreover, a previous study investigating 70 MSM living with HIV reported that individuals with lower HIV-related self-stigma performed better in working memory, a core aspect of executive function ( 41 ). In this regard, self-stigma, especially that related to HIV, may be associated with deficits in executive function.…”

The relationship between substance abuse-associated stigma and deficits in executive functioning

“…Therefore, the stigma associated with substance abuse is linked with impaired executive function. While multiple studies con rm the negative impact of stigma on cognitive functions in psychiatric patients (23)(24)(25), less is known about the effect of executive functioning de cits on self-perceived stigma related to drug use. In a recent study by Wang et al, the link between executive functioning de cits, substance-use-related stigma, and substance use problems was explored among individuals exposed to trauma.…”

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

“…It is important to note that HIV does not define a person, and living with the virus should not be a cause for shame or discrimination. However, due to a lack of education and awareness about HIV, as well as the associated negative stereotypes, many people still suffer from self-stigma, feeling guilty and self-recriminating in a situation that goes far beyond their responsibility [1][2][3][4]. Regarding anticipated stigma, this refers to the prejudices and negative stereotypes that exist in society about HIV and that lead to the exclusion and marginalization of people who could be at risk of con-tracting it [5,6].…”