Objective The Internet is a fundamental tool for completing many different instrumental activities of daily living (IADL), including shopping and banking. Persons with HIV-associated Neurocognitive Disorders (HAND) are at heightened risk for IADL problems, but the extent to which HAND interferes with the performance of Internet-based household IADLs is not known. Methods Ninety-three individuals with HIV disease, 43 of whom were diagnosed with HAND, and 42 HIV− comparison participants completed Internet-based tests of shopping and banking. Participants used mock credentials to log in to an experimenter-controlled website and independently performed a series of typical online shopping (e.g., purchasing household goods) and banking (e.g., transferring funds between accounts) tasks. Results Individuals with HAND were significantly more likely to fail the online shopping task than neurocognitively normal HIV+ and HIV− participants. HAND was also associated with poorer overall performance versus HIV+ normals on the online banking task. In the HAND group, Internet-based task scores were correlated with episodic memory, executive function, motor skills, and numeracy. In the HIV+ sample as a whole, lower Internet-based task scores were uniquely associated with poorer performance-based functional capacity and self-reported declines in shopping and financial management in daily life, but not with global manifest functional status. Conclusions Findings indicate that HAND is associated with difficulties in using the Internet to complete important household everyday functioning tasks. The development and validation of effective Internet training and compensatory strategies may help to improve the household management of persons with HAND.

Older adults living with HIV have trouble "remembering to remember," which affects their abilities to live independently and follow health care provider instructions. This experiment demonstrates that older HIVϩ adults can improve their memory performance in the laboratory by using specific strategies that reduce the cognitive demands of remembering to remember. Future studies using more naturalistic memory methods will determine whether similar improvements in remembering to remember can be achieved in the daily lives and health behaviors (e.g., medication adherence) of older adults with HIV disease.

Objective As the prevalence of older adults living with HIV disease increases, questions are emerging regarding the extent to which older age amplifies the adverse effects of HIV on employment status and functioning. This cross-sectional study sought to: 1) investigate the combined effects of HIV and older age on employment status, 2) identify clinicodemographic correlates of employment status among older HIV+ persons, and 3) examine the combined effects of HIV and age on workplace performance among employed participants. Method The sample was 358 HIV+ (163 Older, 195 Younger) and 193 HIV− (94 Older, 99 Younger) adults, who completed a comprehensive neurocognitive research assessment that included measures of employment status and current workplace functioning. Results We observed main effects of HIV and age on employment status, but no interaction. The Older HIV+ sample demonstrated particularly high rates of disability, rather than elective retirement or unemployment. Among older HIV+ adults significant predictors of employment status included age, global neurocognitive functioning, cART status, age at HIV infection, and hepatitis C co-infection. Finally, self-reported work functioning of Older HIV+ adults differed only from the Younger HIV− group. Conclusions Findings suggest that older age and HIV disease have additive adverse effects on employment status, but not work functioning, and that employment status is associated with both neurocognitive and medical risk factors among older HIV+ adults. Further longitudinal research is needed to elucidate specific disease and demographic characteristics that may operate as protective factors for retaining gainful employment among older HIV+ adults.

Individuals living with HIV disease evidence moderate difficulties in inhibiting statistically unlikely non-random sequences, which showed medium associations with higher order verbal abilities and may contribute to greater declines in everyday functioning outcomes. Future studies might examine RNG's role in health behaviors such as medical decision-making or medication adherence.

Objective Episodic memory deficits are both common and impactful among persons infected with HIV; however, we know little about how to improve such deficits in the laboratory or in real life. Retrieval practice, by which retrieval of newly learned material improves subsequent recall more than simple restudy, is a robust memory boosting strategy that is effective in both healthy and clinical populations. In this study we investigated the benefits of retrieval practice in 52 people living with HIV and 21 seronegatives. Method In a within-subjects design, all participants studied 48 verbal paired associates in 3 learning conditions: Massed-Restudy, Spaced-Restudy, and Spaced-Testing. Retention of verbal paired associates was assessed after short- (30 minutes) and long- (30 days) delay intervals. Results After a short delay, both HIV+ persons and seronegatives benefited from retrieval practice more so than massed and spaced restudy. The same pattern of results was observed specifically for HIV+ persons with clinical levels of memory impairment. The long-term retention interval data evidenced a floor effect that precluded further analysis. Conclusions This study provides evidence that retrieval practice improves verbal episodic memory more than some other mnemonic strategies among HIV+ persons.

Background Limited health literacy is common among persons infected with HIV and has been linked to poor mental and physical health outcomes, but there are no well-validated screening measures of health literacy in this vulnerable clinical population. The present study evaluates the usefulness of the Newest Vital Sign (NVS) as a brief measure of health literacy in HIV disease. Methods Seventy-eight HIV+ adults were administered the NVS, Rapid Estimate of Adult Literacy in Medicine (REALM), and Single Item Literacy Screener (SILS). Main criterion variables included plasma HIV viral load, medication management capacity, self-efficacy for medication management, and perceived relationships with healthcare providers. Results The NVS showed good internal consistency and moderate correlations with the REALM and SILS. Rates of limited health literacy were highest on the NVS (30.3%) as compared to SILS (6.6%) and REALM (9.2%). A series of regressions controlling for education showed that the NVS was incrementally predictive of viral load, medication management capacity and self-efficacy, and relationships with healthcare providers, above and beyond the REALM and SILS. Conclusion The NVS shows evidence of reliability, convergent validity, and incremental criterion-related validity and thus may serve as useful screening tool for assessing health literacy in HIV disease.

Objective: Older persons living with HIV (PLWH) disease commonly experience failures of time-based prospective memory (PM) in their daily lives. This study examined the benefits of providing strategic supports at encoding, monitoring, and cue detection for naturalistic time-based PM among older PLWH. Method: Participants included 116 older PLWH and 48 seronegatives who completed a baseline neuropsychological evaluation (see Woods et al., 2020), including a laboratory PM experiment that paralleled the design of the current naturalistic study. The naturalistic time-based PM task required participants to press a button on a portable PM response box 4 times per day for 1 month. PLWH were randomly assigned to an unsupported control condition or to an experimental group in which strategic processing was supported at encoding (implementation intentions and visualization), monitoring (content-free cuing), and/or cue detection (auditory alarm). The seronegative participants were all assigned to the unsupported control group. Results: In a model adjusting for age and affective disorders, PLWH who received all three supports in combination demonstrated moderately better naturalistic time-based PM accuracy as compared with PLWH controls. Both the cue detection and combination conditions were associated with markedly more precise response timing on the naturalistic time-based PM task. Supported PM accuracy as measured in the laboratory was positively associated with naturalistic PM accuracy among PLWH in the experimental groups. Conclusions: Providing strategic supports to enhance the cue salience of naturalistic time-based PM tasks may improve both the accuracy and timing with which older PLWH remember to perform time-based intentions.Editor's Note. Dr. Yeates served as the action editor for this article.

Hispanic and Black adults are disproportionately affected by HIV and experience poorer HIV-related health outcomes relative to non-Hispanic White adults. The current study adopted Sørensen's integrated model to test the hypothesis that lower functional and critical health literacy competencies contribute to poorer HIV-related health and CD4 cell count for Hispanic and Black individuals. Eighty-one non-Hispanic White, Hispanic, and Black HIV seropositive individuals from a large, Southwestern metropolitan area were administered measures of health literacy, including the Expanded Numeracy Scale, Newest Vital Sign, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy (TOHFLA)-numeracy, and TOHFLA-reading. Hispanic and Black individuals demonstrated less HIV knowledge than non-Hispanic White individuals. Black participants demonstrated fewer health literacy appraisal skills. Importantly, lower levels of health literacy were linked to poorer CD4 cell count (an index of immune functioning) for Hispanic and Black individuals and not for non-Hispanic White individuals. These findings suggest race group differences for health literacy on current CD4 cell count such as very specific dimensions of low health literacy (e.g. poorer judgment of health-related information), but not other presumed deficits (e.g. motivation, access), play an important role in clinical health outcomes in HIV.