Stress and poverty predictors of treatment adherence among people with low-literacy living with HIV/AIDS.
OBJECTIVE
To examine the association of social, health, and poverty-related stressors in relation to antiretroviral therapy adherence in a sample of people with low-literacy living with HIV/AIDS in the southeastern United States. Emotional distress is among the more common factors associated with HIV treatment adherence. Typical barriers to adherence may be overshadowed by poverty experiences in the most disadvantaged populations of people living with HIV/AIDS, such as people with lower-literacy skills.


METHODS
One hundred eighty-eight men and women living with HIV/AIDS who demonstrated poor health literacy completed measures of social and health-related stress, indicators of extreme poverty, as well as other factors associated with nonadherence. HIV treatment adherence was monitored prospectively, using unannounced pill counts.


RESULTS
Two-thirds of the sample demonstrated adherence <85% of pills taken. Multivariable analyses showed that food insufficiency and hunger predicted antiretroviral therapy nonadherence over and above depression, internalized stigma, substance use, and HIV-related social stressors.


CONCLUSIONS
Interventions for HIV treatment nonadherence with the most socially disadvantaged persons in developed countries should be reconceptualized to directly address poverty, especially food insufficiency and hunger, as both a moral and public health imperative.
Kalichman
Seth C
SC
Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT 06269, USA. seth.k@uconn.edu
Grebler
Tamar
T
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D057220:Health Literacy; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data*; D011336:Probability; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*
D044966:Anti-Retroviral Agents