Predictors of HAART adherence among HIV-positive Latino immigrants: An application of the Theory of Planned Behavior

Background: Research has suggested that Latino immigrants living with HIV/AIDS may be at increased risk for HAART nonadherence for a variety of reasons including fear that the risks (e.g., stigma, deportation, side effects) associated with evidence-based medicine outweigh its benefits. Given that non-adherence has severe implications (e.g., medication failure, narrowed treatment options, and development of resistant strains of HIV) and marginal changes in adherence affect the probability of viral suppression, we sought to identify correlates of HAART adherence among HIV+ Latino immigrants receiving medical care for HIV.

Methods: A convenience sample of HIV+ Latino immigrants was recruited from Wake Forest University Infectious Diseases Specialty Clinic. Participants completed an interviewer-administered assessment measuring: demographics, attitudes toward adherence to HAART, subjective norms, perceived behavioral control, and behavioral intentions; acculturation; social support; and trust.

Results: Participants included immigrants from Mexico (n= 50), Puerto Rico (n=5), Honduras (n=4), Guatemala (n=4), and other Central and South American countries (n=10). Their mean age was 37.3 (SD=9.6); 74% were men and 26% were women. Hierarchical multiple regression was used to determine the proportion of variance accounted for by TPB constructs and other variables. Positive attitudes towards HIV medication adherence, subjective norms supporting its use, and perceived behavioral control were each associated with self-reported adherence to HAART. Increased provider and researcher trust were also associated with self-reported adherence.

Conclusion: These findings suggest that TPB is a useful model for predicting adherence to HAART among Latino immigrants; however, distrust may result in inadequate management of disease.