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Health Literacy in HIV Treatment: Accurate Understanding of Key Biological Treatment Principles is Not Required for Good ART Adherence

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Abstract

Findings on the relationship between health literacy and outcomes in HIV have been inconsistent. Health literacy has previously been operationalized as general functional literacy, but has not included content knowledge about HIV disease and treatment. Semi-structured interviews with people living with HIV in 2 U.S. cities, including questions about the etiology, pathophysiology and treatment of HIV. We compared responses to biomedical conceptions. The 32 respondents were demographically diverse. Although most understood that HIV degrades the immune system, none could explain the nature of a virus, or the mechanism of antiretroviral (ARV) drug action. Fewer than half accurately reported that it is desirable to have a high CD4+ cell count and low viral load. A minority understood the concept of drug resistance. While most believed that strict adherence to ARV regimens was important to maintain health, three believed that periodic treatment interruption was beneficial, and three believed they should not take ARVs when they used alcohol or illicit drugs. Respondents generally had very limited, and often inaccurate biomedical understanding of HIV disease. Most reported good regimen adherence but did not have any mechanistic rationale for it. The failure to find a consistent relationship between health literacy and ARV adherence may be largely because most people simply follow their doctors’ instructions, without the need for deep understanding.

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Acknowledgments

This research was supported by the National Institute of Mental Health, 1R21MH092781-01. Thanks to Tanya Bezreh for interviewing.

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Authors and Affiliations

  1. Department of Health Services, Policy and Practice, Brown University School of Public Health, G-S121-7, Providence, RI, 02912, USA

    M. Barton Laws & Ira B. Wilson

  2. Program in Liberal Medical Education, Brown University, Providence, RI, USA

    Michael Danielewicz

  3. Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, USA

    Aadia Rana

  4. Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA

    Laura Kogelman

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  1. M. Barton Laws
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  2. Michael Danielewicz
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  3. Aadia Rana
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  4. Laura Kogelman
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  5. Ira B. Wilson
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Correspondence to M. Barton Laws.

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Laws, M.B., Danielewicz, M., Rana, A. et al. Health Literacy in HIV Treatment: Accurate Understanding of Key Biological Treatment Principles is Not Required for Good ART Adherence. AIDS Behav 19, 635–644 (2015). https://doi.org/10.1007/s10461-014-0931-8

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  • DOI: https://doi.org/10.1007/s10461-014-0931-8

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