HIV medication adherence among Latino and African American clients accessing mental health and substance abuse services

Background: Poor adherence with antiretroviral therapy is associated with depression and psychotic disorders. The present study examines the association between HIV medication adherence and measures of mental health, substance use and quality of life. Participants were recruited during intake to an outpatient mental health program housed within a substance abuse treatment program. The program provides integrated mental health and substance abuse services targeting economically disadvantaged Latino and African Americans with an HIV or AIDS diagnosis. Methods: 120 participants completed an intake interview that included the following instruments: Beck Depression Inventory (BDI), Symptom Checklist-90-R, and the Medical Outcome Study-HIV Health Survey. Participants also completed 3 items assessing HIV medication adherence, which were summed to create an adherence index. Recent alcohol and drug use were assessed using items from the Addiction Severity Index (ASI). Results: 91 (75.8%) participants reported that they were currently being prescribed HIV medication. Adherence was negatively associated with hostility (r=-.24, p<.05) and paranoid ideation (r=-.22, p<.05), and positively associated with quality of life (r=.35, p<.01). There was a marginally significant correlation between levels of depression and adherence (r=-.20, p=.07). Conclusions: In a sample of individuals accessing mental health services, those expressing anger, aggression, suspiciousness and paranoid behavior reported poorer adherence to HIV medication procedures. Measures of paranoid ideation and hostility may provide a useful indicator of poor medication adherence in similar settings.