This cross-sectional study investigated associations between social determinants, risk behaviors, mental health, and two outcomes—antiretroviral therapy (ART) adherence and health-promoting lifestyle—among 120 randomly selected people living with HIV (PLWH) in southeast Iran. Validated instruments (HELIA-SF, HPLP-II, MARS-5, barriers questionnaire) were used. Multivariable logistic and linear regression were applied; all results are correlational. In adjusted models, optimal adherence (≥ 95%) appeared to be associated with being married (adjusted odds ratio [aOR] = 2.01, 95% CI: 1.03–3.92), higher health literacy (per 1 SD increase; aOR = 3.85, 95% CI: 1.16–12.82), better health-promoting lifestyle (per 1 SD increase; aOR = 3.47, 95% CI: 1.08–11.18), and fewer barriers (aOR = 0.94, 95% CI: 0.92–0.96, per 1-point increase in barriers score). However, given the limited sample size relative to the number of predictors (events per variable [EPV] ≈ 4.5), these estimates should be considered exploratory and may be unstable; these associations are correlational and should not be interpreted as causal. Findings suggest that modifiable factors—including health literacy, health-promoting lifestyle, and perceived barriers—are associated with adherence and health-promoting lifestyle in this population. These hypothesis-generating associations support the potential value of holistic, multi-level interventions. However, given the cross-sectional design, limited sample size, and potential overfitting of the logistic regression model (EPV ≈ 4.5), causal conclusions are not warranted, and the findings should be considered exploratory. Longitudinal studies with larger samples are needed to confirm these associations.
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Izadira et al. (2026) studied this question.
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