Influence of Stigma, Depression, and Medication Self-efficacy on Adherence with Anti-retroviral Therapy in Older Adults Living with HIV/AIDS

Background: Adults aged >50 years (older adults by CDC definition) represent a growing proportion of the U.S. population living with HIV/AIDS. Adherence to anti-retroviral therapy (ART), required to improve immune system function, is especially important for older adults living with HIV/AIDS due to increased likelihood of additional medical conditions that could compromise health status. Stigma, depression, and medication self-efficacy are known to influence ART adherence in younger adults, but these influences are poorly understood in older adults; therefore, we examined these interrelationships in older adults (OA) living with HIV/AIDS.

Methods: In-person interviews were conducted with OA living with HIV/AIDS recruited from clinics and community-based organizations. Dependent variable was whether adherent (> 90%) or not with ART, based on the AIDS Clinical Trials Group measure. Independent variables included: 32-item Revised HIV Stigma Scale; 26-item HIV medication Self-Efficacy Scale (higher score=greater self-efficacy); 20-item Center for Epidemiological Studies-Depression Scale.

Results: 72 subjects completed interviews (34% female; mean age=55, range=50-71; 36% African-American, 32% Caucasian, 25% Hispanic). 74% of subjects were adherent with ART. Adherence was positively associated with medication self-efficacy (r = 0.33; p=.008), but adherence was not associated with depression nor with stigma. However, medication self-efficacy was negatively associated with both stigma (r = -.27; p=.035) and with depression (r = -.32; p=.008).

Conclusions: Only medication self-efficacy was directly associated with ART adherence, but medication self-efficacy was influenced by perceived stigma and depression. Public health interventions to maximize medication adherence in OA living with HIV/AIDS must account for psychological factors affecting medication self-efficacy.