Background: Optimal adherence to HIV medications is imperative to prevent AIDS related deaths, the development of opportunistic infections, and drug resistant strains of HIV. African American women are less likely to maintain optimal adherence to HIV medications compared to White and Latina women. Adherence is a complex, multi-faceted and dynamic behavior. Understanding correlates of adherence is necessary for the development of interventions aimed at promoting adherence.

Objective: To describe the internal models of HIV and examine predictors of adherence in African American women living with HIV.

Methods: In this descriptive cross sectional study, African American women between the ages of 18-60 who were living with HIV (N=110) were recruited from an HIV clinic in central Minnesota. The Conceptual Content Cognitive Map exercise and surveys were used to assess the women's HIV internal models and HIV knowledge, directed attention, spiritual well-being, mattering to others, sense of belonging, depressive symptoms, drug and alcohol use and adherence.

Results: The Conceptual Content Cognitive Map exercise revealed that the women believed taking medication, family, children, church and God were positive aspects of their lives living with HIV. Linear regression models were not significant (p = .069) when all study variables were regressed on adherence. The adherence variable was dichotomized in several ways. When adherence was dichotomized into 0-99 and 100 scores, the model was significant (p = .004). Findings indicate that women who scored higher on depressive symptoms and directed attention (as measured by digit span backwards) and had less feeling like they mattered to others were less likely to maintain complete adherence.

Conclusions: Self-reported adherence scores had limited variability and resulted in the study being underpowered. Women had largely positive internal models of HIV, which could partially explain the limited variability in adherence. Future research should utilize different measures for predictor variables that are more in align with the theoretical underpinnings of the framework utilized like exposure to natural environments instead of spiritual well being as a measure of restoration for directed attention. Virologic HIV RNA should be coupled with any self-report adherence measure.