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Health literacy has been recognized as a vital issue in the self-care management of persons living with HIV/AIDS (PLWHA). The purpose of this study was to determine the impact of functional, communicative, and critical health literacy dimensions on positive and negative attitudes toward health decision making. The transtheoretical model of health behavior change (TTM) provided the theoretical framework to explain this association. A culturally-adapted survey was used in this cross-sectional study to measure health literacy dimensions, positive and negatives attitudes toward health decision making, and other factors in 100 Puerto Ricans living with HIV/AIDS. Demographic factors and clinical and immunological variables were obtained from the HIV/AIDS Registry database. Bivariate analyses were conducted to determine associations and multiple logistic regression analyses were used to determine the extent to which health literacy and other factors, while controlling for demographic characteristics, disease duration, and stage of readiness, predicted positive and negative attitudes toward health decision making. Results revealed that Puerto Ricans living with HIV/AIDS with higher health literacy scores are more likely to have positive attitudes toward health decision making. HIV/AIDS disease-specific knowledge and self-report HIV medication adherence showed statistical significance for functional and critical health literacy. Social change implications included the identification of limited health literacy as a potential barrier for an active participation in health decision making. The development of interventions directed to increase health literacy skills to improve HIV medication adherence and disease management are needed.