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.