Abstract
We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and educational attainment among Blacks that are living with HIV. We analyzed data from the regional Survey on HIV in the Black Community in Alabama. HIV-related medical mistrust w or HIV Genocidal Conspiracy Theories were reported by majority of the patients. In multivariable analysis, controlling for income, education, and marital status, belief in conspiracy theories or HIV Genocidal Conspiracy Theories were significantly associated with higher education. The HIV-Related Medical Mistrust Scale item was independently associated with higher education. This finding speaks to the need for an improved understanding of the role of HIV related medical mistrust among African Americans to improve uptake of biomedical HIV prevention.
Keywords: HIV/AIDS Mistrust, HIV conspiracy theories, HIV-related medical mistrust, African American Patients
Introduction
In the United States, there is a disproportionate burden of HIV/AIDS among African Americans. When addressing how that disparity has deepened over time, much of the literature on HIV prevention has emphasized the need to take into account conspiracy theories in African American communities (Parson 2021; Zekeri 2018; 2019; 2021). Almost no research has examined the relationship between HIV genocidal conspiracy theories and cultural issues such as mistrust among African-Americans of the medical profession among people already infected with HIV/AIDS. Mistrust of health care professionals, health care institutions, and government in relation to health care may impact HIV/AIDS prevention efforts. Medical mistrust has been identified as a primary driver of racial and ethnic inequalities in health outcomes in the United States (Parson 1997; Whettenet et al 2021; Zekeri 2021).
Purposes
The purposes of this study are to assess belief in genocidal conspiracy theories about HIV/AIDS; and 2) ascertain the differences, if any, between men, women and education among a sample African Americans in rural Alabama living with HIV.
Method
This study was conducted as part of a larger project examining HIV in rural Alabama (Alabama’s Black Belt). The self-administered survey was conducted at two clinics with an AIDS Outreach Organization in rural Alabama. The clinics provide medical and social support services to HIV-positive persons that lived in a 23 county area in Southeast Alabama including the Black Belt. The clinics also provide complete primary health care that includes physician visits, laboratory tests, case management, food bank, transportation, vouchers for food and emergency assistance to low-income individuals living with HIV. All the 225 respondents were taking antiretroviral medications at the time of the study.
Measures
Items were selected from a previously developed scale (Zekeri 2021) The HIV-Related Medical Mistrust Scale was comprised of four items that reflect two domains of HIV-related medical mistrust: genocidal beliefs and medical mistrust. Medical mistrust items were “There is a cure for HIV, but the government is withholding it from the poor” Genocidal beliefs were “The medicine that doctors prescribe to treat HIV is poison” “HIV is a man-made virus.” “AIDS is a form of genocide against blacks.” “Aids was created by the government to control the black population” “AIDS was produced in a government Laboratory.” Respondents reported their agreement on a 5-point scale [1 (strongly agree) to 5 (strongly disagree)]. Responses were re-coded so that a higher score (1–5) indicated a higher level of mistrust. The scale was from 1(disagree strongly) to 5 (agree strongly).
Data Analysis
Descriptive statistics were generated for sociodemographic variables of interest and HIV-related mistrust variables. Regression analysis was used for the multivariate analysis.
Results
Of the 225 respondents, 57.6% were male, 42.4% were female. Age ranged from 18 to 63; more than half were 34 or younger, and 37.1% were 35 or older. More than half (57.6%) were single, while only 17% were married. About 23% had no formal education up to high school while 31% completed high school. Only 15% had a four-year college degree.
About 48.5% somewhat or strongly endorsed the statement that “HIV is a manmade virus,” while 57.1% agreed that “there is a cure for AIDS, but it being withheld from the poor,” 40.2% believed that “AIDS was produced in a government laboratory.” About one-third belief “AIDS is a form of genocide against Blacks” (32.6%). Twenty-eight percent of the patients said that “AIDS was created by the government to control the black population.” The chi-square statistics showed that gender of the respondents is not significantly associated with HIV genocidal beliefs.
Table 1.
Multivariate sociodemographic predictors of HIV-Related Mistrust (or HIV Genocidal Conspiracy Theories) among African Americans Living with HIV in Rural Alabama.
| Beta | |
|---|---|
| Gender | .032 |
| Education (college) | −.431* |
| Marital Status (married) | −0.291* |
| Age | .321* |
| Adjusted R2 | .119 |
P < 0.05
Regarding education, regression results indicated that education is related to endorsing HIV Genocidal Beliefs. Those with college education were less likely than their non-educated peers to endorse the conspiracy beliefs that “The medicine that doctors prescribe to treat HIV is poison.” and “People who take the new medicines for HIV are human Guinea pigs for the government.” The set of demographic variables explained about 13% of the variation in HIV genocidal conspiracy beliefs in the total sample.
Conclusions
What can be concluded concerning HIV-Related Mistrust (or HIV Genocidal Conspiracy Theories) among African Americans living with HIV? The data suggest that education is associated with HIV-Related Mistrust (or HIV Genocidal Conspiracy Theories). Both men and women who graduated from college were less likely to accept the mistrust. HIV-Related Mistrust (or HIV Genocidal Conspiracy Theories) were not associated with gender in this sample. In this sample there was evidence of a positive relationship between education and Genocidal Beliefs. Many questions, however, remain unanswered. Do the relationship found for this sample of African Americans living with HIV living in rural Alabama, hold for other groups? Do these associations between HIV/AIDS Genocidal Beliefs s and education differ by age, income, geographic region? Additional research is needed to address these questions.
Because of the high incidence of HIV infection among African Americans, HIV prevention intervention which addresses their specific needs as it relates to culture, gender, and educational experience is needed.
Footnotes
Authors’ Note
The opinions and conclusions expressed herein are solely those of the authors. We want to express our deep and sincere gratitude to the HIV-Positive patients that participated in the study. Study procedures were reviewed and approved by the Tuskegee University Office of Research Compliance.
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