Medical Mistrust, Discrimination, and the Domestic HIV Epidemic

Bogart, Laura M.; Takada, Sae; Cunningham, William E.

doi:10.1007/978-3-030-48744-7_12

Cited by 24 publications

(27 citation statements)

References 133 publications

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“…Mistrust, which originates in systemic racism, is a rational coping response to centuries of oppression, starting with slavery, and includes historical and ongoing police brutality, high incarceration rates, poverty, and racial residential segregation of Black people. 24 Mistrust may be further increasing due to the US sociopolitical climate in 2020, in which members of the federal administration used divisive rhetoric (eg, in support of racist movements) at a time when there was a call for action and widespread Black Lives Matter protests to stop police brutality. 53 – 55 Any interventions to address medical mistrust at the local level must acknowledge and address these societal-level reasons for mistrust.…”

Section: Discussionmentioning

confidence: 99%

“… 22 Medical mistrust is a key mediator of the association between discrimination and worse health outcomes and behaviors among Black Americans. 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

“… 25 – 27 Thus, high levels of medical mistrust among Black Americans may arise from history, knowledge, and continuous and repeated discrimination and harmful experiences toward their racial/ethnic group by the health care system and government, which in turn may affect health behaviors because it motivates distrust of governmental and public health information and avoidance of health care, as a self-protective coping strategy. 24 …”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

Bogart

Ojikutu

Tyagi

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

412

414

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Background: Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. Methods: Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. Results: Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = −5.19 (2.08), P = 0.02]. Discussion: To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.

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Section: Discussionmentioning

confidence: 99%

“… 22 Medical mistrust is a key mediator of the association between discrimination and worse health outcomes and behaviors among Black Americans. 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

Bogart

Ojikutu

Tyagi

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

412

414

View full text Add to dashboard Cite

show abstract

“…Their study findings combined with experience and expertise regarding issues of medical mistrust by U.S. Blacks in the context of HIV [ 126 , 127 ] lead Bogart et al to advocate for public health interventions encouraging COVID-19 vaccine uptake and treatment among Blacks to be grounded in community-based partnerships, tailoring community-specific strategies to overcome mistrust and access inequities. For example, offering COVID-19 vaccinations in nonmedical settings may increase vaccine uptake; partnering with faith-based organizations could help facilitate such efforts, a strategy that has already been employed in various local settings [ 128 , 129 , 130 , 131 , 132 , 133 ].…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

Chen

Belin

et al. 2021

IJERPH

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The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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“…14 Limited research has specifically focused on determinants of vaccine confidence among Black individuals. Medical mistrust (defined as distrust of the healthcare system, providers, and treatments 15 , 16 ) may be contributing to vaccine confidence among Black Americans. Medical mistrust has been conceptualized as an understandable, rational, self-protective response to historical and ongoing structural and interpersonal discrimination and racism in healthcare, and lack of trustworthiness of healthcare systems and institutions in U.S. society.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccine Intentions and Mistrust in a National Sample of Black Americans

Bogart

Dong

Gandhi

et al. 2022

Journal of the National Medical Association

Self Cite

103

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Background National data indicate low intentions for COVID-19 vaccination among a substantial minority of Black Americans, and disproportionately lower vaccination rates among Black Americans than White Americans. Methods A total of 207 of the 318 Black participants (65%) in the RAND American Life Panel, a nationally representative internet panel, were surveyed about COVID-19 vaccine intentions in November-December 2020. Participants’ census tracts were geocoded using the Centers for Disease Control and Prevention's Social Vulnerability Index. Results Overall, 35% agreed or strongly agreed that they would not get a COVID-19 vaccine, 40% agreed or strongly agreed that they would get vaccinated, and 25% reported “don't know.” Significant multivariable predictors of not wanting to get vaccinated included high mistrust of the vaccine itself (e.g., concerns about harm and side effects), OR (95% CI ) = 2.2 (1.2–3.9), p = .007, and weak subjective norms for vaccination in one's close social network, OR (95% CI ) = 0.6 (0.4–0.7), p < .001. Residence in an area of higher socioeconomic vulnerability was a marginally significant predictor, OR (95% CI ) = 3.1 (0.9–11.0), p = .08. Conclusions High mistrust around COVID-19 vaccines may lower vaccine confidence. Social network members’ attitudes can be influential in encouraging vaccination. Public health communications could use transparent and clear messaging on safety and efficacy, and acknowledge historical and ongoing discrimination and racism as understandable reasons for low confidence in COVID-19 vaccines. Future research is needed to consider vaccine access challenges in tandem with mistrust as contributing to low vaccination rates across health conditions.

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Medical Mistrust, Discrimination, and the Domestic HIV Epidemic

Cited by 24 publications

References 133 publications

COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

COVID-19 Vaccine Intentions and Mistrust in a National Sample of Black Americans

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