Despite the availability of effective antiretroviral therapy, many people with HIV continue to experience changes in thinking and memory; these changes can affect quality of life and can lead to other negative health outcomes. However, relatively little is known about psychosocial factors that may be associated with cognitive changes in people with HIV. HIV stigma refers to negative beliefs and attitudes about people with HIV. Using the MAPLE dataset (N = 303 people with HIV), we examined associations between HIV stigma and performance on 5 cognitive tasks over a 2-year period. Eighty-nine percent of the sample reported experiencing HIV stigma. People who reported having experienced more stigma at the beginning of the study showed slower processing speed and more difficulty with attentional regulation two years later. Associations between HIV stigma and cognition were apparent after adjustment for potential confounders such as depressive symptoms, age, and reading ability (which reflects educational attainment).
Our paper titled “HIV Stigma is Associated with Two-Year Decline in Cognitive Performance Among People with HIV” is the first to demonstrate that HIV stigma precedes changes in thinking and memory, consistent with (but not proving) a causal relationship. While we were unable to directly test biological or psychosocial pathways that might explain the association, it is possible that HIV stigma may be linked to feelings of loneliness. Loneliness is linked to cognitive decline in people with and without HIV. Additionally, experiences of discrimination and stigma are believed to increase cumulative physiological stress (allostatic load), which over time may impact health and brain function. Regardless of the mechanism explaining our results, our paper highlights the importance of considering HIV stigma when addressing health outcomes among people with HIV.