A study by researchers at Chicago's Northwestern University found HIV patients with low literacy levels frequently do not understand their medication instructions and thus are much less likely to comply with treatment.

The researchers examined the association between health literacy and racial differences in medication adherence in 204 HIV-positive patients attending outpatient clinics in Chicago and Shreveport, La. Eighty percent of the patients were male; 45 percent African-American; the average age was 40.

Overall, 70 percent or more of the participants were taking at least three HIV medications and more than half were being treated for other chronic illnesses, said the researchers.

A health-related word recognition test found 68.6 percent of participants reading at a ninth-grade or higher level (adequate health literacy), while slightly more than 20 percent had a seventh- to eighth-grade reading level (marginal health literacy) and around 11 percent had low health literacy.

When the analysis factored in the effects of age, gender, income, number of medications and non-HIV co-morbidities, African Americans were 2.4 times more likely to be non-adherent than compared with non-African Americans, the study found. When the effects of literacy were considered, "literacy was a significant predictor of non-adherence, such that patients with low literacy were 2.1 times more likely to be non-adherent to their medication than patients with adequate literacy," Dr. Chandra Y. Osborn said.

Limited health literacy is a potentially modifiable barrier to drug adherence, the researchers noted. Patients at risk for non-adherence could benefit from culturally relevant health education materials and drug labeling written for all literacy levels, they suggested.

The study, "Health Literacy: An Overlooked Factor in Understanding HIV Health Disparities," was published in the American Journal of Preventive Medicine (2007;33(5):374-378).

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