Medical mistrust among social network members may contribute to antiretroviral treatment nonadherence in African Americans living with HIV

Abstract

Rationale African Americans living with HIV are less likely to adhere to antiretroviral treatment (ART) compared to other racial/ethnic groups. Medical mistrust is thought to be a factor in this disparity. Objective We examined (1) whether exposure to HIV conspiracy beliefs, a specific type of HIV-related mistrust (about the origins and treatment of HIV) in social networks is associated with ART nonadherence among African Americans living with HIV; and (2) the characteristics of individuals who discuss HIV-related mistrust in the social networks of African Americans living with HIV. Methods At baseline and 6- and 12-months post-baseline, 175 African Americans living with HIV on ART completed egocentric social network assessments, from which we assessed the structure and composition of their personal networks (the social context immediately surrounding them). HIV-related mistrust was operationalized with an indicator of whether any social network member had expressed HIV conspiracy beliefs to the participant. Daily medication adherence was monitored electronically. Results At baseline, 63% of participants agreed with at least one conspiracy belief, and 55% reported hearing at least one social network member (“alter”) express conspiracy beliefs. In a multivariate linear repeated measures regression, expression of conspiracy beliefs by similar others in the network (in terms of age, gender, HIV status, sexual orientation, and race/ethnicity) was associated with ART nonadherence (i.e., percentage of prescribed doses taken). In a multivariate logistic regression, expression of conspiracy beliefs was more likely among social network members who were HIV-positive, who knew the participants’ serostatus, and with whom participants interacted frequently, and less likely among more well-connected social network members. Conclusion HIV-related mistrust in the network may be most influential when expressed by similar others who may be HIV-positive themselves.

The need for multi-level mitigation of medical mistrust among social network members contributing to antiretroviral treatment nonadherence in African Americans living with HIV: Comment on Bogart et al. (2016)

“…Institutional or systemic racism creates an environment in which many African Americans have reduced access to housing, poorer neighborhood quality, lower educational quality and attainment, fewer employment options, and harsher incarceration sentences, all of which can negatively impact health behaviors. Notably, Bogart et al (2016) found that having a history of incarceration and being unemployed were both associated with lower adherence to ART. Cultural racism, evident in the maintenance of negative stereotypes about African Americans, as well as individuals’ experiences of racial discrimination can also have deleterious effects on mental health and health behaviors (Corral & Landrine, 2012; Williams, Neighbors, & Jackson, 2003; Williams & Mohammed, 2013).…”

“…To this end, Bogart et al (2016), in this issue, present an analysis of one potential source of disparate engagement in treatment - medical mistrust of social network members- among African Americans living with HIV.…”

“…In explaining health disparities for African Americans, Bogart et al (2016) commendably implicate multiple levels of influence, including structural, interpersonal (social network), and individual factors. Racism at each of these levels has been posited to have a negative effect on African Americans’ mental and physical health (Williams & Mohammed, 2013).…”

“…To elucidate disparities in HIV care specifically, Bogart et al (2016) cite the role of racial discrimination and the stigma associated with HIV/AIDS, but then focus on the high levels of medical mistrust found among African American communities. Their conceptualization of medical mistrust is based on the endorsement of HIV conspiracy theories, which have previously been identified as having two distinct categories: genocidal beliefs (e.g., HIV was created by humans) and treatment-related beliefs (e.g., HIV medication causes AIDS), both of which have been shown to relate to adherence (Bogart, Wagner, Galvan, & Banks, 2010).…”

“…As Bogart et al (2016) wisely caution, interventions at the structural and interpersonal levels are needed to address the origins and maintenance of medical mistrust, which lie in historical and contemporary discrimination in health care and the wider social milieu . Addressing the origins and maintenance of medical mistrust likely requires a series of multifaceted long-term interventions.…”