Medication literacy and treatment adherence in people living with human immunodeficiency virus: Mediating effects of psychosocial factors

Table 1 Distinct mediating pathways of stigma and their impact on treatment adherence

Mediating pathway	Mechanism of action	Impact on outcomes	Group differences	Ref.
External stigma → medication literacy → adherence	Social exclusion restructures access to health information through institutional discrimination	Patients avoid reading medication inserts, leading to reduced accuracy in understanding drug interactions; an "information desert" emerges	Cultural specificity exacerbates information-processing difficulties; women may face more barriers in accessing health information	[18-20]
Internalized stigma → self-efficacy → adherence	Self-stigmatization undermines treatment confidence via cognitive fusion	Patients pathologically associate HIV status with self-worth, showing a "self-punishment" tendency in treatment decisions	Internalized stigma is positively correlated with psychological inflexibility, associated with reduced gray matter density in the anterior insula	[23,24]
Moderating effects of stigma	Multiple discrimination experiences in racial and sexual minority groups	African American patients exhibit greater distrust toward prescribing intentions; sexual minorities experience unique spatiotemporal stigma burdens	African Americans face dual discrimination (race + HIV status); men who have sex with men report higher internalized stigma in family contexts; transgender women experience a triple-layered stigma effect	[21,27]
Concealment of treatment behavior	Patients adopt systematic concealment strategies to reduce identity exposure risk	Strategies such as altering appointment times or modifying medical records increase complexity and risk in health management	Women are more likely to use "medication repackaging" due to family role conflicts; men who have sex with men build anonymous support systems through virtual networks	[62-65]

HIV: Human immunodeficiency virus.