Promoting HIV Literacy

Abstract

H ealth literacy has a significant impact on our daily lives, affecting almost every aspect of our ability to understand and process information regarding our health. According to the American Medical Association (AMA), poor health literacy is ‘‘a stronger predictor of a person’s health than age, income, employment status, education level, and race.’’ In Health Literacy: A Prescription to End Confusion, the Institute of Medicine (IOM) reported that 90 million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and/or do not understand instructions such as ‘‘take on an empty stomach.’’ There are various examples of low health literacy’s impact. For example, a study of 483 asthma patients found that although two thirds reported graduating from high school, only 60% could read above the sixth-grade level. Reading ability was the single strongest predictor of asthma knowledge. Twice as many patients reading below the third-grade level had poor metered-dose inhaler technique as patients reading at high-school level (89% vs. 48%). And in a study involving 659 public hospital patients, those with poor health literacy skills were 5 times more likely to misinterpret their prescriptions than those with adequate skills. Likewise, in the management of HIV disease, a patient’s level of HIV literacy is critical for treatment success, one of the most important predictors of which is levels of adherence to antiretroviral therapy. A study of 182 HIV-positive adults found that those with low health literacy were more likely to miss doses than those with high health literacy because of confusion about the instructions. Yet another study involving 204 HIV-positive patients showed that low HIV literacy doubled the likelihood of nonadherence to antiretroviral therapy. Low HIV literacy was also demonstrated in the recent AIDS Treatment for Life International Survey (ATLIS), the results of which were published in the July/August 2008 issue of the Journal of the International Association of Physicians in AIDS Care (JIAPAC). This multicountry survey of almost 3000 HIV-positive patients from 6 geographical regions identified some major gaps in HIV literacy. When respondents were asked to describe how HIV drug resistance develops, for example, only 17% accurately answered the question; a total of 54% answered incorrectly or did not know the answer and 29% provided only partially accurate answers. North American (48%) and Asian/Pacific (20%) respondents were most likely to select the correct answer to the question, whereas African respondents were more likely to select an inaccurate answer or did not know (79%), followed by respondents from Latin America (58%) and Europe (54%). Previous studies have shown a strong correlation between a good understanding of HIV drug resistance and improved treatment adherence. Among the ATLIS respondents from the United States and Western Europe, those in the United States (13.3%) were least likely not to know their CD4 count, whereas respondents in Germany (43.6%) and Italy (37.5%) were most likely not to know their CD4 count. When coupled with the vast amount of existing literature about the impact of low health literacy on human health, the ATLIS results represent a wake-up call for the broad community that is engaged in the field of HIV medicine. Improving HIV literacy—by means already explored or by a combination including innovative approaches—will translate into greater treatment success. But this will only occur if it is made a priority alongside the development of newer, less toxic antiretroviral drugs; the expansion of access to antiretroviral therapy by addressing clinical, economic, and social barriers that impede progress; and the further integration of