HIV-positive people who have low literacy levels are less likely than people with higher literacy levels to adhere to their medication regimens because they often don’t understand medication instructions, according to a new study ( Health, 11/15).

Researchers at Northwestern University also found that African Americans living with HIV were more than twice as likely as their white counterparts not to be adherent, and that health literacy reconciled the racial disparities. The researchers examined 204 HIV positive people in Chicago and Shreveport, Louisiana, testing the participants’ recognition of health-related words to determine health literacy levels.

The study is published in the American Journal of Preventive Medicine. The investigators say that culturally appropriate health literacy materials, and labels that can be easily understood by people of all literacy levels, may help people remain adherent.