Marriage, Health Literacy Tied to Better HIV Treatment Adherence in Southeast Iran Study

People living with HIV in southeast Iran who were married, had higher health literacy, followed a healthier lifestyle, and perceived fewer barriers to medication were more likely to take their antiretroviral therapy as prescribed, according to a new cross-sectional study published in AIDS Research and Therapy.

The study surveyed 120 randomly selected people living with HIV and examined how social determinants, risk behaviors, and mental health comorbidities relate to two outcomes: adherence to antiretroviral therapy and engagement in a health-promoting lifestyle. The researchers used validated instruments, including the Health Literacy Instrument short form (HELIA-SF), the Health-Promoting Lifestyle Profile II (HPLP-II), the five-item Medication Adherence Report Scale (MARS-5), and a barriers questionnaire.

In adjusted statistical models, optimal adherence, defined as taking at least 95 percent of prescribed doses, appeared to be associated with being married, with an adjusted odds ratio of 2.01 and a 95 percent confidence interval of 1.03 to 3.92. Higher health literacy was also linked to optimal adherence, with an adjusted odds ratio of 3.85 per one standard deviation increase (95 percent CI: 1.16 to 12.82).

A better health-promoting lifestyle showed a similar pattern, with an adjusted odds ratio of 3.47 per one standard deviation increase (95 percent CI: 1.08 to 11.18). Fewer perceived barriers were associated with higher adherence as well: each one-point increase in the barriers score corresponded to an adjusted odds ratio of 0.94 for optimal adherence (95 percent CI: 0.92 to 0.96).

The authors emphasize that these estimates should be treated with caution. Because the sample of 120 participants was small relative to the number of predictors in the models, with roughly 4.5 events per variable, the logistic regression results may be unstable and are considered exploratory. All findings are correlational by design and cannot establish that any factor causes better adherence.

The cross-sectional design adds a further limitation: social determinants, risk behaviors, mental health, adherence, and lifestyle were all measured at a single point in time, so the direction of any association cannot be determined. The authors note that potential overfitting of the logistic regression model further limits the strength of the conclusions.

Despite these constraints, the researchers argue that the factors identified, including health literacy, health-promoting lifestyle, and perceived barriers, are modifiable, meaning they could in principle be targeted by future interventions. They suggest the results support the potential value of holistic, multi-level approaches that address more than medication alone.

The authors frame the work as hypothesis-generating and call for longitudinal studies with larger samples to confirm whether the observed associations hold over time. Until such studies are done, the findings offer a preliminary map of the social and behavioral factors that travel alongside treatment adherence in this population of people living with HIV in southeast Iran.

Subject of Research: Associations between social determinants, risk behaviors, mental health, and antiretroviral therapy adherence and health-promoting lifestyle among people living with HIV in southeast Iran

Article Title: Social determinants, risk behaviors, and mental health comorbidities in relation to treatment adherence and health-promoting lifestyle among people living with HIV in southeast Iran: a cross-sectional correlational study

Article References: Izadira, H., Masoudy, G., Mohammadi, M. S., & Baygi, M. Z. (2026). Social determinants, risk behaviors, and mental health comorbidities in relation to treatment adherence and health-promoting lifestyle among people living with HIV in southeast Iran: a cross-sectional correlational study. AIDS Research and Therapy. https://doi.org/10.1186/s12981-026-00975-1

Image Credits: AI Generated

DOI: 10.1186/s12981-026-00975-1

Keywords: HIV, antiretroviral therapy adherence, health literacy, health-promoting lifestyle, cross-sectional study, Iran, social determinants, mental health comorbidities, medication barriers, public health, Social, determinants