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Differences in Medical Mistrust Between Black and White Women: Implications for Patient–Provider Communication About PrEP

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Abstract

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provider through medical mistrust. The sample consisted of 501 adult women (241 Black; 260 White) who were HIV-negative, PrEP-inexperienced, and heterosexually active. Black women reported greater PrEP interest and intention than White women. However, Black women expressed higher levels of medical mistrust, which, in turn, was associated with lower comfort discussing PrEP with a provider. Medical mistrust may operate as a unique barrier to PrEP access among Black women who are interested in and could benefit from PrEP.

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References

  1. US Centers for Disease Control and Prevention. HIV/AIDS. 2018. Available from: https://www.cdc.gov/hiv/group/gender/women/.

  2. US Census Bureau. Projections of the population by sex, hispanic origin, and race for the United States: 2015 to 2060. 2014.

  3. Fonner VA, Dalglish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Riddell J, Amico KR, Mayer KH. HIV preexposure prophylaxis: a review. JAMA. 2018;319(12):1261–8.

    Article  PubMed  Google Scholar 

  5. Hanscom B, Janes HE, Guarino PD, Huang Y, Brown ER, Chen YQ, et al. Preventing HIV-1 infection in women using oral pre-exposure prophylaxis: a meta-analysis of current evidence. J Acquir Immune Defic Syndr. 2016;73(5):606–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mayer KH, Krakower DS. Editorial commentary: scaling up antiretroviral preexposure prophylaxis: moving from trials to implementation. Clin Infect Dis. 2015;61(10):1598–600.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102–10.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mera Giler R, Magnuson D, Trevor H, Bush S, Rawlings K, McCallister S. Changes in Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States: (2012–2016). In: 9th International AIDS Society Conference on HIV Science; Paris, France; 2017.

  9. Siegler AJ, Mouhanna F, Mera Giler R, et al. The prevalence of PrEP use and the PrEP-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018; Advance online publication.

  10. Bush S, Magnuson D, Rawlings MK, Hawkins T, McCallister S, Mera Giler R. Racial characteristics of FTC/TDF for pre-exposure prophylaxis (PrEP) users in the US. Boston: ASM Microbe; 2016.

    Google Scholar 

  11. Ball K, Lawson W, Alim T. Medical mistrust, conspiracy beliefs & HIV-related behavior among African Americans. J Psychol Behav Sci. 2013;1(1):1–7.

    Google Scholar 

  12. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Smedley BD, Stith A, Nelson AR, editors. National Academies Press, Washington, DC; 2002.

  13. Washington HA. Medical apartheid: the dark history of medical experimentation on Black Americans from colonial times to the present. Paw Prints. 2010.

  14. Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9(10):1156–63.

    Article  CAS  PubMed  Google Scholar 

  15. Halbert CH, Armstrong K, Gandy OH, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896–901.

    Article  PubMed  Google Scholar 

  16. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.

    Article  PubMed  Google Scholar 

  17. Laveist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44(6):2093–105.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Whetten K, Leserman J, Whetten R, Ostermann J, Thielman N, Swartz M. Exploring lack of trust in care providers and the government as a barrier to health service use. Am J Public Health. 2006;96(4):716–21.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75–82.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol. 2016;21(7):1311–21.

    Article  PubMed  Google Scholar 

  21. Kalichman SC, Eaton L, Kalichman MO, Cherry C. Medication beliefs mediate the association between medical mistrust and antiretroviral adherence among African Americans living with HIV/AIDS. J Health Psychol. 2017;22(3):269–79.

    Article  PubMed  Google Scholar 

  22. Ford CL, Wallace SP, Newman PA, Lee SJ, Cunningham WE. Belief in AIDS-related conspiracy theories and mistrust in the government: relationship with HIV testing among at-risk older adults. Gerontologist. 2013;53(6):973–84.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hoyt MA, Rubin LR, Nemeroff CJ, Lee J, Huebner DM, Proeschold-Bell RJ. HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: effects on HIV testing and risk behaviors. Health Psychol. 2012;31(3):269–77.

    Article  PubMed  Google Scholar 

  24. Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among black men who have sex with men. J Natl Med Assoc. 2004;96(1):97–107.

    PubMed  PubMed Central  Google Scholar 

  25. Bogart LM, Thorburn S. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? J Acquir Immune Defic Syndr. 2005;38(2):213–8.

    Article  PubMed  Google Scholar 

  26. Brooks RA, Allen VC, Regan R, Mutchler MG, Cervantes-Tadeo R, Lee S-J. HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2018;29(4):375–81.

    Article  PubMed  Google Scholar 

  27. Eaton LA, Driffin DD, Smith H, Conway-Washington C, White D, Cherry C. Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. Sexual Health. 2014;11(3):244–51.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among Black and White men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sohler NL, Li X, Cunningham CO. Gender disparities in HIV health care utilization among the severely disadvantaged : can we determine the reasons? AIDS Patient Care STDS. 2009;23(9):775–83.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;28(1):47–58.

    Article  CAS  PubMed  Google Scholar 

  32. Hammond WP, Matthews D, Mohottige D, Agyemang A, Corbie-Smith G. Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. J Gen Intern Med. 2010;25(12):1300–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hill BS, Patel VV, Haughton LJ, Blackstock OJ. Leveraging social media to explore Black women’s perspectives on HIV pre-exposure prophylaxis. J Assoc Nurses AIDS Care. 2018;29(1):107–14.

    Article  PubMed  Google Scholar 

  34. Adams LM, Balderson BH, Brown K, Bush SE, Packett BJ. Who starts the conversation and who receives preexposure prophylaxis (PrEP)?: A brief online survey of medical providers’ PrEP practices. Health Educ Behav. 2018 (Advance Online Publication).

  35. Kelley CF, Kahle E, Siegler A, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Parsons JT, Rendina HJ, Lassiter JM, Whitfield THF, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. J Acquir Immune Defic Syndr. 2017;74(3):285–92.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Dubov A, Altice FL, Fraenkel L. An information-motivation-behavioral skills model of PrEP uptake. AIDS Behav. 2018 (Advance Online Publication).

  38. Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care. 2017;29(6):751–8.

    Article  PubMed  Google Scholar 

  39. Wingood GM, Dunkle K, Camp C, et al. Racial differences and correlates of potential adoption of preexposure prophylaxis (PrEP): results of a national survey. J Acquir Immune Defic Syndr. 2013;63(1):S95–101.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Connecticut Department of Public Health. Epidemiological profile of HIV Connecticut; 2016.

  41. Connecticut Department of Public Health. CT Pre-exposure Prophylaxis (PrEP) Local Medical Services; 2017. Available from: https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/aids_and_chronic/prevention/pdf/PrEPServicespdf.pdf?la=en.

  42. Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The group-based medical mistrust scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209–18.

    Article  PubMed  Google Scholar 

  43. Shelton RC, Winkel G, Davis SN, et al. Validation of the group-based medical mistrust scale among urban Black men. J Gen Intern Med. 2010;25(6):549–55.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Valera P, Boyas JF, Bernal C, Chiongbian VB, Chang Y, Shelton RC. A validation of the group-based medical mistrust scale in formerly incarcerated Black and Latino men. Am J Mens Health. 2018;12(4):844–50.

    Article  PubMed  Google Scholar 

  45. Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med. 2015;49(2):177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  46. United States Department of Commerce Economics and Statistics Administration USCB. Race & Ethnicity; 2017. Available from: https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.

  47. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.

    Google Scholar 

  48. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.

    Article  PubMed  Google Scholar 

  49. Hayes AF. Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr. 2009;76(4):408–20.

    Article  Google Scholar 

  50. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol. 2007;58:593–614.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Fisher WA, Fisher JD, Shuper PA. Social psychology and the fight against AIDS: An information-motivation-behavioral skills model for the prediction and promotion of health behavior change. Adv Exp Soc Psychol. 2014;50:105–93.

    Article  Google Scholar 

  52. Shrestha R, Altice FL, Huedo-Medina TB, Karki P, Copenhaver M. Willingness to use pre-exposure prophylaxis (PrEP): An empirical test of the information-motivation-behavioral skills (IMB) model among high-risk drug users in treatment. AIDS Behav. 2017;21(5):1299–308.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Eiser AR, Ellis G. Cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82:176–83.

    Article  PubMed  Google Scholar 

  54. Calabrese SK, Krakower DS, Mayer KH. Integrating HIV pre-exposure prophylaxis (PrEP) into routine preventive health care to avoid exacerbating disparities. Am J Public Health. 2017;107(12):1883–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Davis SK, Tucker-Brown A. The efffects of social deterinants on Black women’s HIV rik. J Black Stud. 2013;44(3):273–89.

    Article  Google Scholar 

  56. Calabrese SK, Dovidio JF, Tekeste M, Taggart T, Galvao RW, Safon CB, Willie TC, Caldwell A, Kaplan C, Kershaw TS. HIV pre-exposure prophylaxis stigma as a multidimensional barrier to uptake among women who attend Planned Parenthood. J Acquir Immune Defic Syndr; 2018 (Advance Online Publication).

  57. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2014;68(4):225–36.

    Article  Google Scholar 

  58. Mays VM, Mass RM, Ricks J, Cochran SD. HIV and African American women in the U.S. South: a social determinants approach to population level HIV prevention and Intervention efforts. In: Baum A, Revenson TA, Singer J, editors. Handbook of health psychology. 2nd ed. New York: Guilford; 2012. p. 771–802.

    Google Scholar 

  59. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access. AIDS Behav. 2014;18(2):226–40.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Dovidio JF, Fiske ST. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. Am J Public Health. 2012;102(5):945–52.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Mignone J. Social determinants of HIV/AIDS: implications for policies in emergnig markers countries. Int J Bus Emerg Market. 2013;5(1):83–97.

    Article  Google Scholar 

  62. Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor–patient communication: does it make a difference? Patient Educ Couns. 2005;56(2):139–46.

    Article  CAS  PubMed  Google Scholar 

  63. White RO, Chakkalakal RJ, Presley CA, Bian A, Schildcrout JS, Wallston KA, et al. Perceptions of provider communication among vulnerable patients with diabetes: influences of medical mistrust and health literacy. J Health Commun. 2016;21(sup2):127–34.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kenny DA, Judd CM. Power anomalies in testing mediation. Psychol Sci. 2014;25(2):334–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to all individuals who participated in the present study. This study was funded by Yale Center for Interdisciplinary Research on AIDS (CIRA), which is funded by the National Institute of Mental Health under Award Number P30-MH062294. The efforts of S. K. Calabrese were supported by the NIMH via Award Number K01-MH103080. T. Taggart was supported by the NIMH via Award Number T32-MH02003 and the National Institute on Drug Abuse (NIDA) via the HIV/AIDS, Substance Abuse, and Trauma Training Program at the University of California, Los Angeles (R25-DA035692). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health, or Planned Parenthood Federation of America, Inc.

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Authors and Affiliations

  1. Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA

    Mehrit Tekeste & Sarah K. Calabrese

  2. Milken Institute School of Public Health, George Washington University, Washington, DC, USA

    Shawnika Hull & Tamara Taggart

  3. Department of Psychology, Yale University, New Haven, CT, USA

    John F. Dovidio

  4. Yale School of Public Health, Yale University, New Haven, CT, USA

    John F. Dovidio, Cara B. Safon, Tamara Taggart, Trace S. Kershaw & Sarah K. Calabrese

  5. Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA

    John F. Dovidio, Tamara Taggart, Trace S. Kershaw & Sarah K. Calabrese

  6. New York City Department of Health & Mental Hygiene, New York, NY, USA

    Oni Blackstock

  7. Planned Parenthood of Southern New England, New Haven, CT, USA

    Clair Kaplan, Abigail Caldwell & Susan B. Lane

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  1. Mehrit Tekeste
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Correspondence to Mehrit Tekeste.

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Conflicts of interest

S. K. Calabrese has received compensation for her efforts in developing and delivering PrEP education materials. S. Hull receives honoraria for serving on the PrEP for Women Steering Committee for Gilead and has a subcontract with a Gilead-funded research study. The authors do not have other conflicts of interest to disclose.

Ethical Approval

All procedures performed in this study 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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Informed consent was obtained from all individuals included in the study.

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Tekeste, M., Hull, S., Dovidio, J.F. et al. Differences in Medical Mistrust Between Black and White Women: Implications for Patient–Provider Communication About PrEP. AIDS Behav 23, 1737–1748 (2019). https://doi.org/10.1007/s10461-018-2283-2

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