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Poor literacy is linked to poor HIV medication adherence among blacks, and may contribute to HIV health disparities

Poor health literacy may play a role in lower antiretroviral medication adherence among black persons with HIV infection, according to a new study. The researchers examined patient demographics, health literacy, and race among 204 patients with HIV infection, whom they interviewed at 2 clinics in 2001. They used the Rapid Estimate of Adult Literacy in Medicine word-recognition test of 66 health-related words to assess health literacy.

Blacks were 2.4 times more likely to be nonadherent to their HIV medication regimen than whites. However, when literacy was included in the model, the effect of race diminished by 25 percent to nonsignificance. Low literacy, on the other hand, remained significant, doubling the likelihood of not complying with antiretroviral medication. Older age and a greater number of medications in the patient's regimen were also significantly associated with greater likelihood of missed doses.

About one-third of adults studied had either low or marginal literacy skills, that is, they could pronounce 60 words or less of the 66 in the test (8th grade level or lower). Blacks were more likely than whites to have marginal or low literacy skills (52.1 vs. 14.3 percent), and were significantly less likely to have taken all their medications in the past 4 days (60.1 vs. 76.8 percent).

Patients with low literacy were more likely to be nonadherent than those with adequate literacy (52.2 vs. 30 percent). In the context of HIV disease, individuals with low literacy skills are more likely to have a poor working knowledge of their disease and the rationale for and benefits of treatment.

The study underscores the importance of targeting communication strategies concerning HIV medication adherence to patients of all literacy levels to reduce HIV health disparities. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00078).

See "Health literacy: An overlooked factor in understanding HIV health disparities," by Chandra Y. Osborn, Ph.D., Michael K. Paasche-Orlow, M.D., M.A., M.P.H., Terry C. Davis, Ph.D., and Michael S. Wolf, Ph.D., M.P.H., in the November 2007 American Journal of Preventive Medicine 33(5), pp. 374-378.

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