AIDS PATIENT CARE and STDs Volume 20, Number 5, 2006 © Mary Ann Liebert, Inc. Social Stigma Concerns and HIV Medication Adherence LANCE S. RINTAMAKI, Ph.D., 1 TERRY C. DAVIS, Ph.D., 2 SILVIA SKRIPKAUSKAS, B.A., 3 CHARLES L. BENNETT, MD., 1,3 and MICHAEL S. WOLF, Ph.D., M.P.H. 1,3 ABSTRACT The threat of social stigma may prevent people living with HIV from revealing their status to others and serve as a barrier to HIV treatment adherence. We evaluated the effect of such concerns on self-reported treatment adherence using a short, three-item measure among 204 people living with HIV. Overall, the mean age of participants was 40.1 years, 45% were African American, and 80% were male. People with high HIV stigma concerns were 2.5 times less likely to define and interpret the meaning of CD4 count correctly and 3.3 times more likely to be nonadherent to their medication regimen than those with low concerns. Concern over revealing HIV status was the only statistically significant, independent predictor of adher- ence in multivariate analysis. Clinical care directed to individuals living with HIV should therefore include considerations for patient sensitivity to social stigma, such as modifications to medication schedules and referrals for counseling prior to enrollment in antiretroviral ther- apies. 359 INTRODUCTION O VER THE PAST DECADE, advances in the phar- maceutical treatment for HIV have greatly increased the health and lifespan of those liv- ing with the disease. 1–3 However, in order for these medications to work effectively, they must be adhered to with little or no deviation from prescribed regimens. When taken im- properly (such as missing or modifying doses), these medications may subsequently fail to pre- vent viral replication, which may then lead to viral resistance. 4,5 Studies have shown that even minor deviations to the prescribed medication regimen, such as missing one or two doses per month, can promote such resis- tance. 5,6 Moreover, resistant strains of HIV may be transmitted to others, thus limiting the treat- ment options available to those newly infected with these strains. 7 Yet, despite the dangers, poor treatment adherence is common among people living with HIV. 8–11 The associations between specific patient and regimen characteristics with poor HIV medication adherence often have been de- scribed in the literature. Characteristics related to adherence include: regimen complexity, for- getfulness, desires to avoid medication side effects, inadequate patient knowledge, fam- ily/work responsibilities, depression, medica- tion availability, or a desire to simply have breaks from the endless routine of taking pills. 12 Most of these and other identified fac- tors found to be significantly associated with 1 Midwest Center for Health Services and Policy Research, Veteran Affairs Chicago Healthcare System, Chicago, Illinois. 2 Louisiana State University Health Sciences Center, Shreveport, Louisiana. 3 Institute for Healthcare Studies, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.