Effect of neurocognitive impairment on condom use knowledge, self-efficacy, skills and intention among people living with HIV/AIDS

Background: Neurocognitive (NC) impairment may act as a barrier to condom use knowledge, skills, self-efficacy and intentions, particularly among substance-abusing people living with HIV (PLWH).

Methods: This cross-sectional study examined associations between STD/HIV knowledge, sexual assertiveness, demonstrated condom skills and condom self-efficacy on the outcome of intention to use condoms among PLWH in Miami, FL with a history of alcohol abuse (N =364). Participants were split by level of NC impairment: The “impaired” group scored at least one SD<normative means on ≥2 neurocognitive (NC) assessments. Backwards stepwise regression (rejection criterion >0.1) was used to assess relationships between variables for both groups.

Results: The mean age of participants was 44.8 (SD=7.25). Most were males (64%) and 145 (39.8%) were deemed to have some NC impairment. There were no significant differences between the impaired and not impaired groups on any study measures. For participants without NC impairment, self-efficacy (β=.13, p<.001) and sexual assertiveness (.40, p<.001) predicted condom use intention (r²=.31). STD/HIV knowledge was also associated with intention for this group, however in a counterintuitive direction (β=-.42, p<.001). For participants with NC impairment, STD/HIV knowledge dropped out and only self-efficacy (β=.10, p=.03) and sexual assertiveness (β=.47, p<.001) remained predictive of intention (r²=.26).

Conclusion: NC impairment may not affect condom use intention or meaningful predictors such as condom self-efficacy and sexual assertiveness. Impacts of impairment on STD/HIV knowledge should be further investigated using more rigorous NC assessment. Understanding the effects of NC impairment on protective sexual behaviors is important for developing targeted interventions.