Taking HIV medication consistently can be harder when people face financial hardship, food insecurity or unstable housing. New research from the University of Michigan suggests that the economic conditions of the neighborhoods where people live may also play a role.

Published in AIDS and Behavior, the study examined 371 gay, bisexual and other men who have sex with men, all of whom were living with HIV and had male partners. Researchers analyzed participants’ neighborhood economic conditions, individual social and economic challenges, and self-reported adherence to daily HIV medications.

The findings showed that neighborhood disadvantage was indirectly associated with lower medication adherence through individuals’ cumulative exposure to social determinants of health — the social and economic conditions that affect health and access to care. Researchers measured neighborhood disadvantage using a tool developed by the University of Michigan Institute for Social Research.

Overall, 85.4% of participants reported taking at least 90% of their HIV medication during the previous week. Those who faced more social and economic challenges were more likely to report difficulty taking their medication consistently. Participants reporting lower adherence were more likely to experience food insecurity, financial hardship and homelessness.

“As a nurse practitioner, I see how tough it is to take medication every single day, even when it is life-sustaining,” said CHEAR Fellow Loren Dobkin, PhD, MPH, MS, NP, RN, who led the study. “My hope is that tools like this novel measure of neighborhood disadvantage, and understanding how it relates to experiences of hardship, can help re-orient us to the context of people’s lives and to develop more impactful health interventions.”

The findings suggest that helping patients take their medications consistently may require more than individual counseling or reminders. Addressing broader barriers, including access to stable housing and other community resources, could also help improve HIV treatment outcomes.

The researchers noted that the study examined data collected at one point in time, so it cannot establish cause and effect. Further research is needed to understand how neighborhood conditions influence medication adherence over time and whether interventions addressing these challenges can help.