Neurocognitive Performance Differences Between Black and White Individuals with HIV Disease are Mediated by Health Literacy

Objective: Brain health disparities have been reported for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the neurocognitive disparities experienced by Black Americans with HIV disease may be at least partly attributable to health literacy. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the hypothesized relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up inverted model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may help explain the observed neurocognitive health disparities for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer brain health benefits for Black Americans with HIV disease.