Medical Mistrust Among Social Network Members May Contribute to Antiretroviral Treatment Nonadherence in African Americans Living with HIV

Published in: Social Science & Medicine, 2016

Posted on RAND.org on April 22, 2016

by Laura M. Bogart, Glenn Wagner, Harold D. Green, Matt G. Mutchler, David J. Klein, Bryce W McDavitt, Sean Jamar Lawrence, Charles L. Hilliard

Read More

Access further information on this document at Social Science & Medicine

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Questions

  1. Is exposure to HIV conspiracy beliefs, a specific type of HIV-related mistrust (about the origins and treatment of HIV), in social networks associated with ART nonadherence among African Americans living with HIV?
  2. What are the characteristics of individuals who discuss HIV-related mistrust in the social networks of African Americans living with HIV?

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.

Key Findings

  • 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).
  • 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.

Recommendation

Future intervention development work is needed to determine how to target structural factors at the root of mistrust, as well as how to stem the spread of mistrust in networks, which ultimately may be contributing to HIV-related disparities in adherence and survival.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.