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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 9/2008

01-09-2008 | Original Article

Literacy, Social Stigma, and HIV Medication Adherence

Authors: Katherine R. Waite, BA, Michael Paasche-Orlow, MD MA MPH, Lance S. Rintamaki, PhD, Terry C. Davis, PhD, Michael S. Wolf, PhD MPH

Published in: Journal of General Internal Medicine | Issue 9/2008

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Abstract

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.

DESIGN

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).

PARTICIPANTS

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 (≤ 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.
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Metadata
Title
Literacy, Social Stigma, and HIV Medication Adherence
Authors
Katherine R. Waite, BA
Michael Paasche-Orlow, MD MA MPH
Lance S. Rintamaki, PhD
Terry C. Davis, PhD
Michael S. Wolf, PhD MPH
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 9/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0662-5

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