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Medical Mistrust, Discrimination, and the Domestic HIV Epidemic

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HIV in US Communities of Color

Abstract

General medical mistrust and HIV-specific medical mistrust (i.e., conspiracy beliefs about HIV’s origin and treatment) stem from historical and ongoing experiences of structural and interpersonal discrimination, and contribute to racial/ethnic HIV disparities in the United States. Medical mistrust is more prevalent among people of color than White Americans and is associated with HIV prevention and treatment outcomes. We propose a multilevel model in which structural discrimination generally and healthcare specifically lead to the development, spread, and maintenance of medical mistrust in communities and social networks, which in turn affects HIV outcomes through a reluctance to engage with healthcare. Mistrust, conceptualized as a survival mechanism to cope with discrimination and to protect individuals from future mistreatment, can be a resilience resource that motivates individuals and communities to work toward structural change. Research is recommended on multilevel approaches that engage healthcare providers to address discrimination and empower communities to channel mistrust into advocacy.

William E. Cunningham deceased at the time of publication.

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Acknowledgments

The writing of this chapter was supported by National Institute of Nursing Research (NINR) R01NR017334, National Institute of Mental Health (NIMH) and National Institute on Minority Health and Health Disparities (NIMHD) R01MH121256, by Office of the Director, National Institutes of Health and National Institute on Minority Health and Health Disparities R01MD014722, and by NIMH R34MH113413 and P30MH058107 (Bogart); by NIMH P30MH58107 and R01MH103076, National Institute of Drug Abuse (NIDA) R01DA039934, National Institute of Aging (NIA) P30AG021684, NINR R01NR4014789, and the UCLA Clinical and Translational Science Institute (CTSI) NIH/NCATS UL1-TR001881 (This chapter is dedicated to the memory of Dr. William E. Cunningham, who devoted his career to addressing health disparities affecting people of color); and by the VA Office of Academic Affiliations through the National Clinician Scholars Program (Takada). The contents do not represent the views of the United States Department of Veterans Affairs or the United States Government.

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  1. RAND Corporation, Santa Monica, CA, USA

    Laura M. Bogart PhD

  2. Division of General Internal Medicine, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Sae Takada MD, PhD & William E. Cunningham

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  2. Sae Takada MD, PhD
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  3. William E. Cunningham
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Correspondence to Laura M. Bogart PhD .

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  1. Division of Global Health Equity, Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA

    Bisola O. Ojikutu

  2. Division of General Internal Medicine, Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA

    Valerie E. Stone

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Bogart, L.M., Takada, S., Cunningham, W.E. (2021). Medical Mistrust, Discrimination, and the Domestic HIV Epidemic. In: Ojikutu, B., Stone, V. (eds) HIV in US Communities of Color. Springer, Cham. https://doi.org/10.1007/978-3-030-48744-7_12

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