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. 2019 Oct;23(10):2859-2869.
doi: 10.1007/s10461-019-02464-1.

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

Ahnalee M Brincks  1 , Karen Shiu-Yee  2 , Lisa R Metsch  2 , Carlos Del Rio  3 , Robert P Schwartz  4 , Petra Jacobs  5 , Georgina Osorio  6 , James L Sorensen  7 , Daniel J Feaster  8
Affiliations

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

Ahnalee M Brincks et al. AIDS Behav. 2019 Oct.

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.

Keywords: Discrimination; HIV; Health care engagement; Medical mistrust.

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Figures

Figure 1:
Figure 1:
Structural Equation Model regressing viral load on engagement with HIV primary care. Viral load was also regressed on all covariates (paths omitted from figure).
See this image and copyright information in PMC

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