Physician Mistrust, Medical System Mistrust, and Perceived Discrimination: Associations with HIV Care Engagement and Viral Load
Medical mistrust is an important risk factor for many health outcomes. For individuals with HIV and substance use co-morbidities, mistrust may influence engagement with health care, and affect overall health and transmission risk. Medical mistrust can be measured by an individual’s mistrust of his/her physician, or mistrust of the medical system. This study examined both types of mistrust among 801 substance-using individuals with uncontrolled HIV infection. The aims were to determine how physician mistrust, medical system mistrust, and discrimination experiences were associated with engagement in HIV primary care. Findings indicated higher levels of physician mistrust, but not medical system mistrust, were associated with a longer time since the last visit to an HIV provider. Longer time since seeing an HIV care provider was associated with higher viral load. This study refines our understanding of the relationship between mistrust and HIV care engagement for a large, diverse sample of substance-using individuals.
KeywordsMedical mistrust HIV Discrimination Health care engagement
This study was funded by the National Institute on Drug Abuse (U10DA013720, UG1DA013720, U10DA013035, UG1DA013035, U10DA013034, UG1DA013034, U10DA013727, UG1DA013727, U10DA020024, UG1DA020024, U10DA013732, UG1DA013732, U10DA015831, UG1DA015831, U10DA015815, UG1DA015815, U10DA020036, U10DA013043, U10DA013045, and T32-DA037801). We also acknowledge support from the Emory University CFAR (P30AI050409) and the University of Miami CFAR (P30A1073961).
Compliance with Ethical Standards
Conflict of interest
Dr. Schwartz provides consultation to Verily Life Sciences. All other authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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