An exploration study of the relationship between executive function and sexual behaviors among people living with HIV

Condomless sex and multiple sexual partners are common among people living with HIV (PLWH), increasing the risk of HIV transmission and other sexually transmitted infections (STIs). Executive function has been linked to sexual behaviors in the general population, but its role among PLWH remains underexplored. This study aimed to explore the association between three domains of executive function (inhibition, working memory, and task monitor) and sexual behaviors (condomless sex and/or multiple sex partners) among PLWH. We conducted a cross-sectional study involving 335 PLWH. Logistic regression was used to examine the association between executive function and engagement in condomless sex and/or multiple sex partners. An analytical framework including interaction tests, correlation analysis, and subgroup analyses was applied to identify moderators. The prevalence of condomless sex and/or multiple sex partners among PLWH was 47.8%. After adjusting for confounding variables, participants with poorer executive function were more likely to engage in condomless sex or have multiple sex partners (OR = 2.34, 95%CI:1.38-3.96, P＜0.001). We identified four moderators including family income, education level, alcohol use and co-infection with other STIs. These findings suggest that reduced executive function is potentially related to more likely of condomless sex and multiple sex partners among PLWH. Interventions designed to enhance executive function may provide a novel pathway for promoting safer sexual practices in this population. Particular attention should be given to individuals with additional risk factors such as lower income, higher education, co-infection with STIs, and alcohol use.