Enacted Sexual Minority Stigma, Social Support, and Cognitive Function Among Midlife and Older Men Who Have Sex with Men from the Multicenter AIDS Cohort Study

Men who have sex with men (MSM) in midlife and older adulthood experience many health disparities to their heterosexual peers that can be attributed, in part, to their stigmatized sexual minority identity or behavior. However, how psychosocial factors affect cognitive function among MSM has yet to be explored. This dissertation analyzed data from the Healthy Aging Study, a sub-study of the Multicenter AIDS Cohort Study (MACS) to explore the effects of social support and enacted sexual minority stigma on three tests of cognitive function. In the first analysis, social support was associated with a lower Trail Making Test (TMT) Part A score at baseline (b = -2.01, 95% CI = -3.24, -0.77) and across 2 years (b = -1.76, 95% CI = -2.42, -1.10), indicating better psychomotor ability. Social support was also associated with a higher Symbol Digit Modalities Tasks (SDMT) score at baseline (b = 2.28, 95% CI = 0.22, 4.34) and across 2 years (b = 1.05, 95% CI = 0.20, 1.90), indicating better information processing. In the second analysis, at baseline enacted sexual minority stigma was associated with higher TMT Part B/A ratios, indicating worse set-shifting performance (b = 0.14, 95% CI = 0.06, 0.22) and fewer correct answers on the SDMT (b = -1.63, 95% CI = -2.81, -0.44). Longitudinally, enacted sexual minority stigma was associated with higher TMT B/A ratios (b = 0.04, 95% CI = 0.01, 0.07). In the third analysis, experiencing or witnessing enacted sexual minority stigma during adolescence were not associated with cognitive function. However, we observed significant moderating effects of social support at baseline between witnessing enacted sexual minority stigma in adolescence and the TMT B/A ratio, and enacted sexual minority stigma experienced in adulthood and the SDMT score. Longitudinally, social support moderated the association between adulthood enacted sexual minority stigma and the TMT A and SDMT scores. The public health significance of these analyses shows that psychosocial factors such as sexual minority stigma may contribute to additional risk for poor cognitive function among MSM, and that social support may be an important resource to mitigate negative effects of social stressors