Literacy, social stigma, and HIV medication adherence.
BACKGROUND
Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated.


OBJECTIVE
To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence.


METHODS
Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ).


METHODS
Two hundred and four consecutive patients participated.


RESULTS
Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th-8th grade) or low (< or = 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3-8.7; p < 0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3-7.7).


CONCLUSIONS
While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.
Health Literacy and Learning Program, Institute for Healthcare Studies, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. k-waite@northwestern.edu
Katherine R
KR
Waite
Michael
M
Paasche-Orlow
Lance S
LS
Rintamaki
Terry C
TC
Davis
Michael S
MS
Wolf
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance / Q000523:psychology*; D011287:Prejudice; D012307:Risk Factors; D012752:Shame; D013240:Stereotyping
D044966:Anti-Retroviral Agents