Gender differences in antiretroviral adherence among HIV-infected adults receiving care in the United States, 2007-2008

Background: Adherence to antiretroviral therapy (ART) is essential to maintain health and reduce HIV transmission. Studies find HIV-infected women are less adherent to ART than men and have different reasons for discontinuing therapy. Fewer studies have explored gender differences in factors influencing adherence. Methods: We conducted cross-sectional analyses using interview data collected from 6/2007 to 9/2008 from the Medical Monitoring Project, a supplemental surveillance system that monitors HIV-infected adults receiving care in U.S. Multivariate logistic regression was used to assess factors associated with nonadherence to ART among 2431 men and 830 women. Results: 18% of women and 12% of men reported nonadherence to ART (p=<.01). For both men and women, multivariate models show older age and white versus black race were associated with better adherence. Among men, nonadherence was associated with receipt of public assistance [adjusted OR (aOR)=1.3, 95% confidence interval [CI]=1.0-1.8], reporting depression all (aOR=2.4, CI=1.4-4.2) or most (aOR=1.7, CI=1.1-2.8) compared with none of the time, crack use (aOR=1.9, CI=1.2-3.0), binge drinking (aOR=1.7, CI=1.2-2.3), and per-unit increase in number of daily medication doses (aOR=1.2, CI=1.1-1.3). Among women, nonadherence was associated with reporting depression all (aOR=3.3, CI=1.5-7.6) compared with none of the time and per-unit increase in years since HIV diagnosis (aOR=1.1, CI=1.0-1.1). Conclusions: Women were significantly less adherent to ART than men. Factors associated with nonadherence varied by gender. Evidence suggests adherence interventions should address substance abuse for men and mental health for men and women. Focusing on maintaining long-term adherence may be particularly important for women.