HIV-positive Gay Men Research Articles

Poor record linkage sensitivity biased outcomes in a linked cohort analysis

ObjectivesTo examine the validity of deterministic compared to probabilistic record linkage in the ascertainment of hospitalizations in two linked cohorts. Study Design and SettingHIV-negative (HIV-ve) (n = 1,325) and HIV-positive (HIV+ve) gay and bisexual men (n = 557) recruited in Sydney, Australia, were probabilistically and deterministically linked to a statewide hospital registry (July 2000–June 2012). ResultsUsing probabilistic linkage as the reference standard, deterministic linkage had higher specificity but much lower sensitivity [34.67% (95% confidence interval: 33.44, 35.92)]. A disproportionate number of links missed were individuals with poorer socioeconomic and health indicators, including HIV status. Risk of hospitalization compared to the general male population [HIV+ve standardized incidence ratio (SIR) = 1.45 (1.33–1.59); HIV-ve SIR = 0.72 (0.67–0.78)] was significantly underestimated when deterministic linkage was used [HIV+ve SIR = 0.46 (0.37–0.58); HIV-ve SIR = 0.29 (0.24–0.35)]. The impact of linkage strategy on the calculation of incidence rate ratios (IRRs) was less, but a greater discrepancy in IRRs was seen for diagnostic categories where event rates were low or where the sensitivity of the deterministic linkage was differential between the two cohorts. ConclusionLinkage without proven high sensitivity and specificity should be carefully considered. In circumstances of undetermined sensitivity, SIRs should not be calculated as the extent of underestimation is unknown. The comparison of linked events within or between cohorts is more robust to linkage misclassification; however, selection bias does affect estimates and should be considered before linkage.

The Road Less Travelled: Exploring Gay and Bisexual Men's Explanations of 'Uncommon' Routes of HIV Transmission.

Although there are practices other than condomless anal intercourse that may result in HIV transmission among gay and bisexual men, very little is known about these 'uncommon' transmission explanations. To address this topic, the free text survey responses from 465 HIV positive gay men in Australia were thematically analysed; 123 participants offered uncommon explanations for their seroconversion. Men described several sexual acts they believed led to infection, categorised as adventurous sex (e.g., fisting) and foreplay (e.g., oral sex). Participants also identified mediating factors associated with their seroconversion, either internal (e.g., cum/pre-cum) or external (e.g., sores, illness) to sex. Finally, contextual forces associated with infection were also explored, namely physical spaces (e.g., sex on premises venues) or mental states (e.g., depression). While some uncommon explanations are unlikely to have resulted in HIV transmission, these accounts reveal the diverse and intersecting ways that men attempt to make sense of their seroconversion.

How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men.

We compared self-described HIV-positive (31.6%, n=445), HIV-negative (56.8%, n=801), and HIV-unknown (11.6%, n=164) gay and bisexual men on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8% of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men.

AIDS Activists, FDA Regulation, and the Amendment of America's Drug Constitution

This Article explores how AIDS activists, desperate for access to potentially life-saving pharmaceuticals, permanently transformed America’s “drug constitution.” Their advocacy altered the FDA’s interpretation and application of the federal Food, Drug, and Cosmetic Act (FDCA) so as to expedite the availability of new, unproven drugs for critical illnesses, thus enhancing individual patients’ autonomy to make therapeutic choices without government interference.The FDCA is more than simple set of instructions to a federal agency — it is a source of vitally important and deeply entrenched institutional and normative frameworks. Like major civil rights, antitrust, and environmental statutes, the FDCA should be viewed as a quasi-constitutional “superstatute.” Therefore, the AIDS activists’ FDA reform campaign of the late 1980s and early 1990s should be understood as a “constitutional” movement, even though it rarely invoked the United States Constitution and pursued its goals entirely outside of court. As a result of the AIDS movement’s efforts, federal drug regulation today reflects not only the FDCA’s original foundational principle of protecting consumers from hazardous protects, but also the (often contrary) fundamental goal of promoting the expeditious release of potentially effective treatments for severe illnesses. The AIDS activists’ successful advocacy regarding drug access permanently shifted decision-making power previously exercised by the FDA to individual patients and their physicians.In addition to linking the AIDS movement to other major civil rights campaigns focused on the implementation of statutes, this Article details a particularly remarkable advocacy effort that has gone mostly overlooked in the legal literature. The Article examines how a movement composed largely of members of a scorned and marginalized population — HIV-positive gay men — significantly altered a crucial body of law administered by one of the country’s most powerful federal agencies. As the Article describes, the AIDS movement achieved this success in a seemingly incongruous alliance with conservative libertarians. Rather than simply telling a triumphal story, however, this Article explores how the AIDS movement was ultimately torn apart by deep schisms that prevented it from ever coalescing around a fully coherent medical libertarian philosophy. The most profound of these divisions, rooted in the very nature of controlled clinical research, concerned the moral acceptability of limiting terminally ill people’s freedom to try experimental drugs to ensure the production of reliable data regarding the treatments’ effectiveness. Ambivalence about the proper resolution of this quandary — among activists and society as a whole — has inhibited a radical dissolution of the FDA’s gatekeeping power. Nevertheless, as this Article concludes, federal regulation of medical products is now very different than it would have been without the AIDS activists’ determined efforts.

Gay Poz Sex: A Sexual Health Promotion Intervention for HIV-Positive Gay and Bisexual Men

Despite the widespread use of cognitive-behavioral therapy and motivational interviewing techniques among behavioral clinicians, most mental health clinicians do not know how to use these techniques for HIV prevention and sexual health promotion. Even less information is available to clinicians on how to work with HIV-positive gay and bisexual men who are at risk for transmitting HIV due to condomless anal sex. The purpose of the present paper is to assist behavioral therapists who are treating HIV-positive gay and bisexual men who engage in sexual behavior that may place them at risk for transmitting HIV or for other sexually transmitted infections. Gay Poz Sex is a form of small group counseling that uses the Information-Motivation-Behavioral Skills model (e.g., Fisher & Fisher, 2000) as the theoretical basis, and a combination of psychoeducation, motivational interviewing, and cognitive-behavioral skills such as stimulus control and role-play exercises. The treatment has the goal of promoting a positive sense of sexual well-being and reducing sexual behavior associated with the transmission of HIV, such as condomless anal sex. This paper illustrates, using three case examples, the application of empirically supported therapy techniques to reduce condomless anal sex for HIV-positive gay and bisexual men.

From Acute Palliation to Chronic Care: Using the Narratives of Two Gay Caregivers to Explore Experiences of Providing HIV Support Across Sociohistorical Contexts

Despite the longstanding shift in conceptualizing HIV/AIDS as a site of chronic care, versus one of acute palliation, few attempts have been made to examine caregiving in the context of this change. This study constitutes a preliminary attempt at exploring the evolving nature of HIV/AIDS caregiving among sexual minorities, primarily by comparing the narratives of two partnered caregivers of HIV-positive gay men whose stories are located in disparate sociohistorical contexts. Whereas one caregiver provided support during an era in which HIV/AIDS was primarily conceptualized as acutely life-limiting, the other did so in the contemporary period of chronic HIV care. Although similarities are noted across the stories, distinctions are also apparent in how the caregivers encounter expressions of homophobia and HIV stigma, and negotiate these realities distinctly as a function of sociohistorical context. In particular, despite the salience of these systemic barriers across the two narratives, these expressions of marginalization appear to occur more routinely and indefinitely in the context of chronic care. This article concludes with implications of the study's findings on theory, research, policy, and practice.

High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada.

BackgroundThe re-emergence of syphilis among HIV-positive gay and other men who have sex with men (MSM) requires vigilance. We estimated incidence of and risk factors for first and subsequent syphilis diagnoses among MSM in HIV care in Ontario, Canada.MethodsWe analyzed data from 2,280 MSM under follow-up from 2006 to 2010 in the Ontario HIV Treatment Network Cohort Study (OCS), a multi-site clinical cohort. We obtained syphilis serology results via record linkage with the provincial public health laboratory. Rates were calculated using Poisson regression.ResultsFirst syphilis diagnoses occurred at a rate of 2.0 per 100 person-years (95 % CI 1.7, 2.4; 121 cases) whereas the re-diagnosis rate was 7.5 per 100 person-years (95 % CI 6.3, 8.8; 136 cases). We observed higher rates over time and among men who were aged <30 years, receiving care in the two largest urban centers, or had a previous syphilis diagnosis. Syphilis diagnosis was less common among Indigenous men, men with higher CD4 cell counts, and, for first diagnoses only, among men with less than high school education.ConclusionsCompared to reported cases in the general male population, incidence of a new syphilis diagnosis was over 300 times greater among HIV-positive MSM but year-to-year changes reflected provincial trends. Re-diagnosis was common, suggesting treatment failure or re-infection. Novel syphilis control efforts are needed among HIV-positive MSM.

Social media use and HIV transmission risk behavior among ethnically diverse HIV-positive gay men: results of an online study in three U.S. states.

Though Black and Hispanic men who have sex with men (MSM) are at an increased risk for HIV, few HIV risk reduction interventions that target HIV-positive MSM, and even fewer that use technology, have been designed to target these groups. Despite similar rates of social media and technology use across racial/ethnic groups, online engagement of minority MSM for HIV prevention efforts is low. Since minority MSM tend to have less representation in online HIV prevention studies, the goals of this online anonymous study of HIV-positive gay-identified men were to test the feasibility of conducting targeted recruitment by race/ethnicity and sexual orientation, to assess technology and social media use, and to assess global HIV transmission risk. In 2011, an anonymous online survey was conducted among 463 members of an HIV-positive personals website. Emails were sent to a subset of HIV-positive male members who self-identified as gay. While 57% were White, substantial proportions of participants were Black (20%) or Hispanic (18%). Median age was 46 (range 18-79). Men who reported using 3 or more websites or apps to meet sex partners were significantly more likely to report anal intercourse (AOR 4.43, p<.001) and condomless anal sex (CAS) (AOR 2.70, p<.05) in the past 3months. The only predictor of CAS with HIV-negative or unknown status partners was being under age 30 (AOR 3.38, p<.01). This study helped to inform online targeted recruitment techniques, access to technology and social media use, and sexual risk among a diverse sample of HIV-positive gay men. Efficacy trials of technology-based HIV prevention interventions targeting high-risk minority HIV-positive MSM are warranted.

Understanding the Irony: Canadian Gay Men Living with HIV/AIDS, Their Catholic Devotion, and Greater Well-being

Nine Canadian Catholic HIV-positive gay men were interviewed to obtain a better understanding of why and how they were able to persevere in their faith despite their religion's teachings against homosexuality and contributions to the stigmatization of HIV/AIDS. By examining the lived experiences and personal perspectives of the participants, the study aimed to explore and elucidate the significant role of Catholicism and the Catholic Church both as a continued source of marginalization and oppression, as well as strength and support, for Canadian gay men living with HIV/AIDS today.

Aggregate and event-level associations between substance use and sexual behavior among gay and bisexual men: Comparing retrospective and prospective data

BackgroundDespite limited research, some evidence suggests that examining substance use at multiple levels may be of greater utility in predicting sexual behavior than utilizing one level of measurement, particularly when investigating different substances simultaneously. We aimed to examine aggregate and event-level associations between three forms of substance use – alcohol, marijuana, and club drugs – and two sexual behavior outcomes – sexual engagement and condomless anal sex (CAS). MethodAnalyses focused on both 6-week timeline follow-back (TLFB; retrospective) and 30-day daily diary (prospective) data among a demographically diverse sample of 371 highly sexually active HIV-positive and HIV-negative gay and bisexual men. ResultsModels from both TLFB and diary showed that event-level use of alcohol, marijuana, and club drugs was associated with increased sexual engagement, while higher aggregated frequency marijuana and any frequency club drug use were associated with decreased sexual engagement. Event-level use of club drugs was consistently associated with increased odds of CAS across both TLFB and diary models while higher frequency marijuana use was most consistently associated with a lower odds of CAS. ConclusionsFindings indicated that results are largely consistent between retrospective and prospective data, but that retrospective results for substance use and sexual engagement were generally greater in magnitude. These results suggest that substance use primarily acts to increase sexual risk at the event-level and less so through individual-level frequency of use; moreover, it primarily does so by increasing the likelihood of sex on a given day with fewer significant associations with the odds of CAS on sex days.

Minority Stress, Depression and HIV-Progression Biomarkers: An Exploratory Study on a Sample of Italian HIV-Positive Gay and Bisexual Men

Gay and bisexual men may experience stress due to their social minority status, which is caused by the manifestations of sexual stigma. Stress, in turn, promotes depression and physical health impairments, two major issues in the context of HIV infection. Thus, the relationships between the manifestations of sexual orientation stigma (enacted sexual stigma, the expectations of discrimination from one's family, and internalized homophobia) with depression and HIV-progression biomarkers (CD4+ cell counts and viral load) have been tested. The participants (N = 120) were gay and bisexual HIV-positive Italian men recruited via the Internet. The results of our analyses confirmed that enacted sexual stigma (e.g., homophobic physical aggression) correlated with depression and viral load. Internalized homophobia was associated with a greater level of depression and lower CD4+ cell counts, whereas the expectations of discrimination indirectly corresponded to lower CD4+ cell counts through internalized homophobia. In conclusion, the manifestations of sexual stigma are linked to poorer mental and physical health in HIV-positive gay and bisexual men. Minority stress, then, is an important concept that needs to be further addressed in the contexts of HIV care.

Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas

Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21–48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies.

Hepatitis C risk factors, attitudes and knowledge among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia.

Background There are increasing reports of sexual transmission of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM). Still unclear is the level of HCV knowledge and the risk factors specific to HCV transmission among this population. This study compared HCV knowledge and risk practices among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia. Participants (n=534) completed an online survey assessing sexual risk practices, HCV knowledge, perceived risk of acquiring HCV and perceptions of people with HCV and who inject drugs. HIV-positive participants were older, reported greater engagement in sexual risk and injecting drug practices, felt they were at greater risk of acquiring HCV, were less likely to socially and sexually exclude people with HCV and had more positive attitudes towards people who inject drugs and people with HCV compared with HIV-negative and HIV-untested participants. HIV-untested participants were younger, reported fewer HCV-related serosorting practices and were more likely to socially and sexually exclude people with HCV than the other groups. Findings suggest that HCV education and prevention for gay men may be most effective if tailored according to HIV status. For HIV-positive men, health promotion could focus on specific sexual practices and biological factors linked to HCV transmission, regular HCV testing and better strategies for disclosure of HCV serostatus. For HIV-negative and HIV-untested men, there should be a more general focus on awareness, changing attitudes towards HCV testing and increasing general knowledge around HCV, including evidence of sexual transmission.

A case of Kaposi sarcoma in an immunocompetent, heterosexual Irish man: a discussion of etiology and viral transmission

Four types of Kaposi sarcoma (KS) have been described, all of which are caused by human herpesvirus-8 (HHV-8). The incidence of KS in the United States is highest among HIV-positive homosexual men and elderly men of Eastern European, Jewish, or Mediterranean descent. However, few reports describe KS in HIV-negative, immunocompetent heterosexual men in the United States. HHV-8 is transmitted largely via saliva and close sexual contact, whereas there are only a handful of reports of transmission via blood and blood products. We report a case of an HIV-negative, immunocompetent heterosexual man who acquired KS via blood transfusion. A 77-year-old immunocompetent, monogamously heterosexual, HIV-negative Irish man presented with a biopsy-proven KS lesion on the right thigh. Past surgical history included a coronary artery bypass graft, during which he received a blood transfusion from an unknown donor source. His ecchymotic KS lesions progressed while on doxycycline, intralesional vinblastine, and topical anti-angiogenic medications. The patient eventually achieved stabilization of KS lesions with acitretin. Our case report emphasizes the need to characterize the phenotype and transmission route of HHV-8 in heterosexual, immunocompetent patients in geographic regions with low HHV-8 seroprevalence.

Gay and bisexual men's awareness and knowledge of treatment as prevention: findings from the Momentum Health Study in Vancouver, Canada.

IntroductionAwareness and knowledge of treatment as prevention (TasP) was assessed among HIV-positive and HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in Vancouver, Canada.MethodsBaseline cross-sectional survey data were analyzed for GBMSM enrolled, via respondent-driven sampling (RDS), in the Momentum Health Study. TasP awareness was defined as ever versus never heard of the term “TasP.” Multivariable logistic regression identified covariates of TasP awareness. Among those aware of TasP, men's level of knowledge of TasP was explored through an examination of self-perceived knowledge levels, risk perceptions and short-answer definitions of TasP which were coded as “complete” if three TasP-related components were identified (i.e. HIV treatment, viral suppression and prevention of transmission). Information source was also assessed. Analyses were stratified by HIV status and RDS adjusted.ResultsOf 719 participants, 23% were HIV-positive, 68% Caucasian and median age was 33 (Interquartile range (IQR) 26,47). Overall, 46% heard of TasP with differences by HIV status [69% HIV-positive vs. 41% HIV-negative GBMSM (p<0.0001)]. In adjusted models: HIV-positive GBMSM were more likely to have heard of TasP if they were Canadian born, unemployed, not using party drugs and had higher CD4 counts; HIV-negative GBMSM were more likely to have heard of TasP if they were Caucasian (vs. Aboriginal), students, had higher education, a regular partner and multiple sexual partners. Among those aware of TasP 91% of HIV-positive and 69% of HIV-negative GBMSM (p<0.0001) felt they knew “a lot” or “a bit in general” about TasP; 64 and 41% (p=0.002) felt HIV treatment made the risk of transmission “a lot lower”; and 21 and 13% (p<0.0001) demonstrated “complete” TasP definitions. The leading information source was doctors (44%) for HIV-positive GBMSM and community agencies (38%) for HIV-negative GBMSM, followed by gay media for both populations (34%).ConclusionsNearly half of GBMSM in this study reported having heard of TasP, yet only 14% demonstrated complete understanding of the concept. Variations in TasP awareness and knowledge by HIV status, and key socio-demographic, behavioural and clinical factors, highlight a need for health communication strategies relevant to diverse communities of GBMSM in order to advance overall TasP health literacy.

Diagnostic technologies in practice: gay men's narratives of acute or recent HIV infection diagnosis.

Diagnosing HIV-positive gay men through enhanced testing technologies that detect acute HIV infection (AHI) or recent HIV infection provides opportunities for individual and population health benefits. We recruited 25 men in British Columbia who received an acute (n = 13) or recent (n = 12) HIV diagnosis to engage in a longitudinal multiple-methods study over one year or longer. Our thematic analysis of baseline qualitative interviews revealed insights within men’s accounts of technologically mediated processes of HIV discovery and diagnosis. Our analysis illuminated the dialectic of new HIV technologies in practice by considering the relationship between advances in diagnostics (e.g., nucleic acid amplification tests) and the users of these medical technologies in clinical settings (e.g., clients and practitioners). Technological innovations and testing protocols have shifted experiences of learning of one’s HIV-positive status; these innovations have created new diagnostic categories that require successful interpretation and translation to be rendered meaningful, to alleviate uncertainty, and to support public health objectives.

Substance Use and Sexual Risk Differences among Older Bisexual and Gay Men with HIV

Bisexual and gay men are disproportionately affected by HIV/AIDS. Research typically combines these groups into the category of men who have sex with men, and little is known about between-group differences. HIV-positive populations are aging and have high rates of substance use compared to non-infected peers, while substance use among older adults has increased and is associated with unprotected intercourse. Among a sample of 239 HIV-positive bisexual and gay men aged 50 and older, bisexual men were more likely to report cigarette, cocaine, crack, and heroin use compared with gay men. However, bisexual men were less likely to use crystal meth, club drugs, poppers (nitrate inhalers), and erectile dysfunction (ED) medications compared to gay men. While bisexual men reported lower rates of unprotected sex, logistic regression analysis found that current use of poppers and ED drugs, which were higher among gay men, explained this difference. Implications for education and prevention programs are discussed.

Younger age, recent HIV diagnosis, no welfare support and no annual sexually transmissible infection screening are associated with nonuse of antiretroviral therapy among HIV-positive gay men in Australia.

With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined. Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used. A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40; 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66; 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78; 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20; 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55; 95% CI 1.03-2.34) were independently associated with ART nonuse. Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.

Shame, self-acceptance and disclosure in the lives of gay men living with HIV: An interpretative phenomenological analysis approach

Objective: HIV-related stigma is a major driver of poor prognosis for the treatment and reduced spread of HIV. The present article provides a qualitative analysis surrounding various themes related to stigma and shame as a result HIV.Design: Eight gay men recruited from a community HIV clinic contacted the researchers in response to a study involving participation in a structured, eight-week group intervention for HIV-related stigma. Following this group, three men took part in open-ended interviews about their thoughts and experiences.Methods: Interpretative phenomenological analysis was used to examine the participants’ experiences surrounding shame and stigma related to living with HIV.Results: Three superordinate themes were identified: social support and the disclosure of serostatus, stigma associated with serosorting and attempts to negotiate a spoiled identity.Conclusion: In San Francisco, a city with a great deal of acceptance surrounding HIV and a large, politically active community of persons living with HIV, gay men continue to struggle with disclosure and stigma. This stigma may be an unexpected result of a high degree of HIV testing and attempts by both HIV-positive and negative gay men to practise serosorting.

Age- and education-matched comparison of aging HIV+ men who have sex with men to general population on common neuropsychological assessments.

Little is known about the impact of HIV and aging on cognitive functioning. This New York City cross-sectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.