AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #217 - Mind and meth: profiles of neurocognitive functioning and the link between risky sexual behavior and substance use
Authors: Presenting Author: Dr. Tyrel Starks - Center for HIV Educational Studies and Training
Additional Authors: Dr. Jeffrey Parsons, Dr. Sarit Golub,
Aim: Links have been established between substance use and neurocognitive impairment as well as between substance use and risky sexual behavior. Links have also been established between neurocognitive impairment and risk taking generally. It is therefore possible that neurocognitive functioning may play a role in the co-occurance of substance use and risky sexual behavior; however, work in this area has been limited. In previous analyses, profiles of scores on tests of executive functioning were associated with risky sexual behavior and substance dependence among HIV negative men. The goals of the current study were to 1) examine the cluster structure of executive functioning skills in a sample of HIV positive men and 2) test whether profiles of executive functioning predicted substance use, risky sexual behavior, and/or their association in a sample of HIV positive men who have sex with men (MSM).
Method / Issue: The analytic sample included 108 HIV-positive MSM between the ages of 24 and 58 (M = 41.35, SD = 8.17). All participants completed a battery of neurocognitive tests including the Iowa Gambling Task (IGT), IGT variant (IGTv), Wisconsin Card Sort (WCS), the Counting Span (CS), False Alarms (FA), and a Go-No-Go task (GnG). In addition, participants provided basic demographic information and day-level data related to substance use and unprotected anal intercourse (UAI) in the previous 14 days.
Results / Comments: Results of cluster analyses on tests of executive functioning suggested that a three cluster solution provided the best fit to the data. Examination of cluster profiles revealed an Intact cluster (successful performance across all measures; N = 21); a Globally Impaired cluster (impairment across all measures; N = 42) and an Decsion-making (DM) Impaired cluster (impairment on the IGT and the IGTv but successful performance on all other measures; N = 45). After controlling for age, men in the DM-Impaired cluster were significantly less likely to use meth on a given day than those in either the Intact (expB = .58; p ≤ .05) or Global (expB = 0.44; p ≤ .05) clusters. However, the day-level relationship between meth use and UAI was significantly stronger for the DM Impaired cluster, compared to the Globally Impaired cluster, such that meth use on a given day was associated with an over 5-times increase in odds of UAI for DM Impaired individuals (expB = 5.16; p ≤ .05). There was also a significant trend suggesting a similarly increased relationship between meth use and UAI for individuals in the Intact cluster as well (expB = 6.62; p < .06).
Discussion: After controlling for age, DM impaired men are less likely to use meth than any other group; however, the effects of meth on the likelihood of UAI are stronger for DM impaired men compared to men who are globally impaired. These results suggest that selective impairment on the IGT and IGTv – i.e. on decision-making tasks – may increase vulnerability to risk-taking in the context of substance use.
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