HIV-Related Medical Mistrust, HIV Testing, and HIV Risk in the National Survey on HIV in the Black Community

Abstract

Black Americans are greatly affected by HIV disparities and exhibit high levels of medical mistrust, including HIV conspiracy beliefs, a form of mistrust around HIV's origin and treatment. A 2002-2003 national survey of Black Americans found that 48% believed that "HIV is a manmade virus." However, the extent to which such beliefs remain widespread is unknown. Moreover, HIV conspiracy beliefs have been associated with greater HIV risk, but have also been associated with a higher testing likelihood-and no research to date has attempted to explain these seemingly contradictory findings. We obtained updated data on prevalence and correlates of HIV conspiracy beliefs from the US National Survey on HIV in the Black Community, a nationally representative e-mail survey of 868 Black individuals aged 18-50 years (February-April 2016). Substantial percentages agreed that HIV is man-made (31%) and that the government is withholding a cure for HIV (40%). HIV conspiracy beliefs and HIV risk were both significantly associated with a higher HIV testing likelihood. The association between HIV conspiracy beliefs and HIV testing was significantly mediated by individual-level HIV risk (73% of total effect), but not by area-level socioeconomic position (an ecological determinant of higher HIV prevalence). Mistrust remains high among Black Americans, but the association of mistrust with prevention behaviors is complex. People who do not trust the public health system may also be at greater risk-and thus, more likely to get tested, potentially due to greater access to community-based testing venues that engage higher risk populations.

Keywords: African American/Black; HIV/AIDS; medical mistrust; survey methods.

Figure 1.

Proposed model showing individual-level HIV risk and area-level socioeconomic position (SEP) mediating the association between HIV-related mistrust and HIV testing.