The Prevalence and Social Determinants of HIV-Associated Neurocognitive Disorders among American Indians and Alaskan Natives
American Indian and Alaskan Native people living with HIV (AI/AN PLWH) have the poorest HIV survival rates of any U.S racial/ethnic group (CDC, 2015 & 2016), suggesting limited access and utilization of health care. However, no studies to date have examined HIV-associated Neurocognitive Disorder (HAND) or the potential social determinants of HAND in this population. This cross-sectional study aimed to identify the prevalence and social determinants (i.e., HIV clinical characteristics, comorbid conditions, quality of education) of HAND among AI/AN PLWH. An English-speaking sample of 109 AI/AN and 105 non-Latinx white (NLW) PLWH (86.4% Male; Mage = 41.5 ± 9.9 years; Meducation = 12.9 ± 3.1 years) completed comprehensive neurocognitive, functional, neuromedical, and psychiatric/substance use evaluations (Heaton et al., 2010). The Wide Range Achievement Test- Edition 3 (WRAT-3) Reading Subtest served as a proxy for quality of education. A series of multinomial and binomial stepwise logistic regression analyses were conducted to examine the effects of ethnoracial status and social determinants of health upon HAND and neurocognitive impairment. AI/AN PLWH demonstrated worse social determinants of health as defined by nadir CD4, CD4 cell count per mL < 200, and WRAT-3 (all ps ≤ .05). The prevalence of HAND was greater among the AI/AN group compared to the NLW group (64.0% vs. 40.0%; χ2(1) = 14.6, p < .01). AI/AN PWH were 7.1 times at greater risk for neurocognitive impairment (B(SE) =.39(.15), χ2 = 6.9, p < .01). The WRAT-3 was the only social determinant significantly associated with ethnoracial disparity in neurocognitive impairment (all ps ≤ .01). Reducing the increased risk for HAND is a priority among AI/AN PWH. This study provides insight into the modifiable risk factors for HAND, particularly emphasizing social determinants of neurocognitive health. Future work should examine possible disparity in neurocognitive decline among AI/AN PLWH.
Neurosciences|Native American studies|Psychobiology|Virology
Savin, Micah J, "The Prevalence and Social Determinants of HIV-Associated Neurocognitive Disorders among American Indians and Alaskan Natives" (2020). ETD Collection for Fordham University. AAI28030575.