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

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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.

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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).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, East Lansing, MI, USA

    Ahnalee M. Brincks

  2. Department of Sociomedical Sciences, Columbia University, New York, NY, USA

    Karen Shiu-Yee & Lisa R. Metsch

  3. Department of Global Health, Emory University, Atlanta, GA, USA

    Carlos del Rio

  4. Friends Research Institute, Baltimore, MD, USA

    Robert P. Schwartz

  5. National Institute on Drug Abuse, Bethesda, MD, USA

    Petra Jacobs

  6. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Georgina Osorio

  7. Department of Psychiatry at the University of California San Francisco, San Francisco, CA, USA

    James L. Sorensen

  8. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Daniel J. Feaster

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  1. Ahnalee M. Brincks
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  2. Karen Shiu-Yee
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  3. Lisa R. Metsch
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  4. Carlos del Rio
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Correspondence to Ahnalee M. Brincks.

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Dr. Schwartz provides consultation to Verily Life Sciences. All other authors declare that they have no conflicts of interest.

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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.

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Brincks, A.M., Shiu-Yee, K., Metsch, L.R. et al. Physician Mistrust, Medical System Mistrust, and Perceived Discrimination: Associations with HIV Care Engagement and Viral Load. AIDS Behav 23, 2859–2869 (2019). https://doi.org/10.1007/s10461-019-02464-1

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