Race, Health Literacy, and HIV Medication Adherence

Objective: Limited health literacy may contribute to racial disparities in health. This study examined the mediating effect of limited health literacy on the relationship between race and HIV medication adherence.

Methods: A total of 204 patients infected with HIV were recruited from two clinics. Structured in-person interviews were conducted to obtain information on patient demographics, medication adherence, and health literacy. Multivariate regression models examined the associations between race, literacy, and HIV medication adherence after adjusting for relevant covariates.

Results: In an adjusted analysis that excluded literacy, African Americans were 2.40 times more likely to be non-adherent to their HIV medication regimen than Whites. When literacy was included in the final model, the effect estimates of race diminished 25% to non-significance. Literacy remained a significant independent predictor of non-adherence.

Conclusion: In this study, limited health literacy mediated the relationship between race and HIV medication adherence. Investigators need to consider the potential utility of ameliorating literacy barriers in healthcare as part of interventions to reduce racial health disparities. The development of educational interventions for medication management that are both appropriate for lower literate audiences and culturally sensitive may both improve HIV medication adherence, and reduce racial disparities on this outcome.