December 7, 2009
The high prevalence of medical mistrust among African Americans may affect health care behaviors such as adherence to antiretroviral therapy. The current study investigated whether a specific type of medical mistrust -- HIV conspiracy beliefs -- is associated with nonadherence to ARV therapy among HIV-positive African-American men.
The investigators enrolled 214 HIV-positive African-American men who completed baseline surveys. The men were asked about their agreement with nine HIV conspiracy beliefs. In addition, participants reported sociodemographic characteristics, depression symptoms, substance use, disease characteristics, medical mistrust, and health care barriers. Among 177 men, ARV adherence was electronically monitored for one month after baseline.
Confirmatory factor analysis revealed two distinct conspiracy subscales: genocidal beliefs (e.g., HIV is manmade) and treatment-related beliefs (e.g., people adhering to ARV therapy are human guinea pigs). Both were related to nonadherence in bivariate tests. In multivariate logistic regression, only treatment-related conspiracies were associated with a lower likelihood of sub-optimal adherence at one-month follow-up (odds ratio = 0.60, 95 percent confidence interval = 0.37 to 0.96, P<0.05).
"HIV conspiracy beliefs, especially those related to treatment mistrust, can contribute to health disparities by discouraging appropriate treatment behavior," the authors concluded. "Adherence-promoting interventions targeting African Americans should openly address such beliefs."