FIG. 3.

Schema of social, behavioral and clinical factors related to virologic response for individuals receiving antiretroviral therapy (ART). Pill adherence is necessary for viral load (VL) suppression; however, access to ART is neither necessary nor sufficient. Individuals can obtain ART from family or friends and may not swallow pills despite obtaining them. Socioeconomic factors (i.e., transportation to clinic) and co-morbid illnesses have a more direct effect on ART access. Likewise, concomitant medications and psychosocial factors (i.e., stigma, disclosure, and depression) are more directly associated with ART adherence but also impact ART access. Institutional (healthcare, religious, governmental), community (neighborhood, dyadic) and societal (cultural, infrastructure, policy) factors have more global impact at all lower levels in this paradigm. (Color for this image can be found at www.liebertpub.com/apc.)