The relationship between executive function, risky behaviour and HIV in young women from the HPTN 068 study in rural South Africa

ABSTRACT

Executive function (EF) may predict sexual risk-taking and HIV risk in young women in rural South Africa. We tested associations between EF and seven risky behavioural outcomes: binge drinking, illicit substance use, unprotected vaginal sex, concurrent sexual relationships, transactional sex, herpes simplex virus type 2 (HSV-2) infection, and HIV infection. We compared EF in young women with HIV to matched controls. 1080 young women underwent cognitive assessments. Better verbal short-term memory was associated with a lower risk of HSV-2 (OR 0.77; 95% CI 0.69, 0.86; p < 0.001). Uncorrected trends (p < 0.05) were better verbal working memory being associated with a lower risk of concurrency, better planning with a lower risk of illicit drug use, and better affective inhibition with a lower risk of transactional sex. 78 participants with sexually acquired HIV were matched with 153 HIV-negative controls and had poorer verbal working memory than controls (Hedge’s g = −0.38; 95% CI −0.66, −0.10; p = 0.0076), but this was non-significant after adjustment. EF’s contribution to young women’s risky behaviour in this context does not hold when stringent statistical corrections are applied, with only verbal short term memory reaching statistical significance as predictor. Replication in other samples is recommended.

KEYWORDS:

• Risky behaviour
• HIV
• executive function
• adolescent girls and young women
• sub-Saharan Africa

Acknowledgements

The authors would like to thank the study site team at the MRC/Wits Agincourt Research Unit, the project managers Linda Kimaru and Busisiwe Mayindi who supervised cognitive data collection for this study, the fieldworkers who administered the assessments, as well as all the participants and caregivers who volunteered their time to participate. The copyright for the Oxford Cognitive Screen – Executive Function (OCS-EF) and the OCS-Plus are claimed by the University of Oxford. For permission to use the tools, please approach the authors in the first instance. KR is funded by the Rhodes Trust, the Africa-Oxford initiative (AfiOx-32), and the Society for Education and Music Psychology Research (SEMPRE) Gerry Farrell scholarship. Overall support for the HIV Prevention Trials Network (HPTN) was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Centre), UM1AI068617 (HPTN Statistical and Data Management Centre), and UM1AI068613 (HPTN Laboratory Centre). The study was also funded under Award Number 5R01MH087118-02 and R24 HD050924 to the Carolina Population Centre. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Allergy and Infectious Diseases [grant number UM1AI068613, UM1AI068617, UM1AI068619]; National Institute of Mental Health [grant number 5R01MH087118-02]; National Institute on Drug Abuse [grant number R24 HD050924]; Africa-Oxford Initiative [AfiOx-32]; Rhodes Scholarships; Society for Education, Music and Psychology Research.