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Physician Mistrust, Medical System Mistrust, and Perceived Discrimination: Associations with HIV Care Engagement and Viral Load

  • Ahnalee M. BrincksEmail author
  • Karen Shiu-Yee
  • Lisa R. Metsch
  • Carlos del Rio
  • Robert P. Schwartz
  • Petra Jacobs
  • Georgina Osorio
  • James L. Sorensen
  • Daniel J. Feaster
Original Paper

Abstract

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.

Keywords

Medical mistrust HIV Discrimination Health care engagement 

Notes

Funding

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.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ahnalee M. Brincks
    • 1
    Email author
  • Karen Shiu-Yee
    • 2
  • Lisa R. Metsch
    • 2
  • Carlos del Rio
    • 3
  • Robert P. Schwartz
    • 4
  • Petra Jacobs
    • 5
  • Georgina Osorio
    • 6
  • James L. Sorensen
    • 7
  • Daniel J. Feaster
    • 8
  1. 1.Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingUSA
  2. 2.Department of Sociomedical SciencesColumbia UniversityNew YorkUSA
  3. 3.Department of Global HealthEmory UniversityAtlantaUSA
  4. 4.Friends Research InstituteBaltimoreUSA
  5. 5.National Institute on Drug AbuseBethesdaUSA
  6. 6.Icahn School of Medicine at Mount SinaiNew YorkUSA
  7. 7.Department of Psychiatry at the University of California San FranciscoSan FranciscoUSA
  8. 8.Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiUSA

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