AIDS and Behavior

, Volume 11, Issue 3, pp 385–392 | Cite as

Medication Beliefs as Mediators of the Health Literacy–Antiretroviral Adherence Relationship in HIV-infected Individuals

  • Joseph Graham
  • Ian M. Bennett
  • William C. Holmes
  • Robert Gross
Original Paper


Identifying modifiable barriers to antiretroviral adherence remains an important aim. We hypothesized that mistaken beliefs regarding taking HIV medications mediated the relation between low literacy and poor adherence. We studied 87 HIV-infected individuals on standard antiretroviral regimens for ≥ 3 months. Adherence was assessed using pharmacy refill records. Medication beliefs, including an individual’s norm for acceptable adherence, were measured using questions developed by expert panel. Literacy was associated with ≥95% adherence (64% for ≥9th grade level vs. 40% for <9th grade level). Participants with <95% adherence had a lower threshold of acceptable adherence than those with ≥95% adherence [80% adherence (interquartile range 70–90%) vs. 90% adherence (interquartile range 80–90%)]. However, the effect was independent of literacy. No other beliefs assessed were associated with adherence. Although the beliefs assessed do not mediate the relation between literacy and adherence, we identified low adherence norms as a potentially modifiable belief associated with adherence.


HIV-1 Antiretroviral therapy Adherence Health literacy 



This project was supported (or supported in part) by an Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics cooperative agreement (grant # HS10399), the PENN AIDS Clinical Trials Unit (U01-AI32783), the PENN Center for AIDS Research (P30-AI45008), and National Institutes of Mental Health grant MH-01854. Dr Holmes is supported by a Research Career Development award from the Health Services Research and Development Service of the Department of Veterans Affairs.


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Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Joseph Graham
    • 1
  • Ian M. Bennett
    • 1
  • William C. Holmes
    • 2
    • 4
    • 5
  • Robert Gross
    • 3
    • 4
  1. 1.Department of Family Medicine and Community HealthUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Division of General Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Division of Infectious Diseases, Department of MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  5. 5.Center for Health Equity Research and PromotionPhiladelphia VA Medical CenterPhiladelphiaUSA

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