Literacy, Social Stigma, and HIV Medication Adherence

  • Katherine R. Waite
  • Michael Paasche-Orlow
  • Lance S. Rintamaki
  • Terry C. Davis
  • Michael S. Wolf
Original Article



Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated.


To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence.


Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ).


Two hundred and four consecutive patients participated.


Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th–8th grade) or low (≤ 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3–8.7; p < 0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3–7.7).


While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.


literacy stigma HIV medication adherence 



Grant support


Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Katherine R. Waite
    • 1
  • Michael Paasche-Orlow
    • 2
  • Lance S. Rintamaki
    • 3
    • 4
  • Terry C. Davis
    • 5
  • Michael S. Wolf
    • 1
  1. 1.Health Literacy and Learning Program, Institute for Healthcare Studies, Division of General Internal Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBostonUSA
  3. 3.Department of CommunicationState University of New YorkBuffaloUSA
  4. 4.Department of Health BehaviorState University of New YorkBuffaloUSA
  5. 5.Louisiana State University Health Sciences CenterShreveportUSA

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