Use of complementary and alternative medicine and its association with antiretroviral therapy adherence and quality of life among people living with HIV in urban Indonesia: a cross-sectional study.

HIV remains a major global health concern, and complementary and alternative medicine (CAM) is often used alongside antiretroviral therapy (ART). This cross-sectional study assessed CAM use, associated factors, perceptions, and relationships with ART adherence and health-related quality of life (HRQoL) among people living with HIV (PLHIV) in Indonesia. From June to September 2025, 400 PLHIV attending three primary healthcare centers in Makassar completed standardized interviewer-administered questionnaires. Overall, 158 (39.5%) reported current CAM use, predominantly herbal remedies. In exploratory bivariate analyses, CAM use was associated with older age, comorbidity, family support, self-reported mode of HIV acquisition, and hospitalization history (all p < 0.05). CAM users more frequently perceived CAM as safer than conventional treatment (65.2% vs. 40.9%). ART-adherence categories differed between groups (p = 0.006), although high adherence was comparable (87.3% vs. 88.8%). CAM use was associated with a lower EQ-5D-5L utility index in the unadjusted analysis (B = -0.039; 95% CI: -0.065 to -0.013), but not after adjustment (B = -0.020; 95% CI: -0.046 to 0.006). CAM use was not associated with EQ-VAS scores. CAM use was common but was not independently associated with poorer HRQoL. Routine CAM screening and individualized counseling may help identify potential CAM-ART interactions and support safe HIV care.