The Role of Sociocultural Factors on the Iowa Gambling Task in HIV

In the United States, HIV disproportionately affects Latinx compared to non-Hispanic white (NHW) adults. Moreover, HIV is known to cause executive dysfunction in HIV+ adults. However, decision-making, an important aspect of executive functioning, is not well-characterized using objective measures in HIV+ adults. While the Iowa Gambling Task (IGT) provides objective measurement of decision-making, the construct validity of the IGT in Latinx populations is unknown. Importantly, sociocultural factors including quality of education (QoE), acculturation, socioeconomic status (SES), language dominance, and perceived ethnic discrimination are known to affect performance on neuropsychological measures. Thus, the aim of this study was to characterize the relationship between the IGT and sociocultural factors in an ethnically diverse sample of HIV+ adults. This study included an archival sample of 91 HIV+ adults (64 Latinx and 27 NHW) who participated in the Medication Adherence Study at the Icahn School of Medicine at Mount Sinai. Participants completed the IGT; a sociocultural evaluation that included measures of QoE, acculturation, SES, language dominance, and perceived ethnic discrimination; a comprehensive neuropsychological evaluation; and a neuromedical examination. No statistically significant between-group differences among the Latinx and NHW HIV+ adults were detected on the IGT. However, the NHW participants demonstrated higher decision-making ability scores on each of the IGT variables measured, with small-to-medium effects, suggesting that the IGT may have better construct validity for NHW compared to Latinx HIV+ adults. Among the Latinx sample, with the exception of language dominance, each sociocultural variable was associated with at least one decision-making variable. Further, there was a robust association between QoE and decision-making on IGT Deck A, both between-groups and among the Latinx sample. Together, these results add to the literature indicating that sociocultural factors should be considered when examining neuropsychological functioning, in particular, decision-making. Moreover, the results have important clinical implications for HIV healthcare providers, suggesting that culturally-tailored treatment planning and risk-management may be warranted when working with ethnically diverse patients