Conspiracy Beliefs about HIV/AIDS among HIV-Positive African American Men and Women in Alabama’s Black Belt: A Mixed-Method Analysis

Abstract

Despite prior studies showing that a significant proportion of the general African-American population hold conspiracy beliefs about HIV/AIDS, limited research has investigated conspiracy beliefs among African Americans that are HIV-positive and the subgroups most likely to endorse such beliefs. I examined endorsement of HIV/AIDS conspiracy beliefs and their relationship to sociodemographic variables among 256 African Americans with HIV infection. Quantitative and qualitative methods were used in the study at an AIDS Outreach Organization clinic in Alabama that provides medical and social support services to HIV-positive persons. Patients reported agreement with statements capturing beliefs in HIV/AIDS conspiracies. Results indicated that about one-third subscribed to the notion that “AIDS is a form of genocide against Blacks” (29.7%) and some 27.7% of the respondents said that “AIDS was created by the government to control the black population.” Regarding treatment-related conspiracy beliefs, over one-third (35.6%) somewhat or strongly agreed that “people who take the new medicines for HIV/AIDS are human guinea pigs for the government,” while 29.9% somewhat or strongly endorsed the statement that “the medicine that doctors prescribe to treat HIV is poison.”

Results of multivariate analyses indicated that stronger HIV/AIDS conspiracy beliefs were significantly associated with educational attainment and age. A set of sociodemographic variables explained a small amount of the variance in conspiracy beliefs about HIV/AIDS (R² range=0.13–0.14). Qualitative results indicated that conspiracy beliefs are barrier to medication adherence among these patients living with HIV/AIDS. Focus group discussions suggested that conspiracy beliefs can be important barriers to quality of life and infection control among HIV-positive individuals. These findings suggested that addressing conspiracy beliefs should be a significant issue in HIV/AIDS treatment and prevention programs in the 21st Century.

Introduction

The human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS) has been plaguing black communities across the United States. African Americans are infected at a disproportionately higher rate than other ethnic groups. Although they are about 13% of the population, African Americans made up 51% of HIV/AIDS cases reported in 2020 by the 33 states using confidential, name-based reporting (Parson 2021).

Clearly, there is a need for a rigorous prevention and treatment efforts as well as programs in African American communities to prevent and stop the spread of HIV/AIDS. Some studies over the past three decades revealed that many African Americans endorsed conspiracy beliefs about HIV/AIDS (Parsons 2021; Zekeri 2009; 2018; 2019) and emphasized the need to take into account these beliefs when discussing HIV/AIDS prevention strategies among African Americans.

Although these studies have documented the prevalence of HIV/AIDS conspiracy beliefs in the general African-American population and the implications of the beliefs for preventing HIV, I found limited study that examined conspiracy beliefs among African Americans with HIV infection in the rural south. Only one study examined conspiracy belief concerning the creation of AIDS by the government and information being withheld about the disease in a sample of 611 HIV-Positive individuals (Whetten et al., 2006). The reason for this dearth of information may be due to the difficulty in getting those infected with HIV/AIDS to participate in exploratory studies. If efforts to prevent and also stop the spread of HIV/AIDS in black communities are to be beneficial, we should take into consideration the beliefs of African Americans with HIV infection about the origins of the disease. Patient factors such as myth about HIV and distrust of the medical system may influence effective treatment of African American patients.

As an extension of my previous research (Zekeri 2009; 2016; 2018; 2019) and that of other researchers (Bogart and Bird 2005; Bird and Bogart 2005; Herek 1994; Klonoff and Landrine 1999; Parson et. al., 1999; Parsons 2021), the current study examined the extent to which African Americans with HIV infection living in Alabama’s Black Belt, the home of the Tuskegee Syphilis study, endorse a range of conspiracy beliefs about HIV/AIDS and the relationship of their sociodemographic characteristics (gender, educational attainment, and age) to their beliefs. It is important to document whether African Americans with HIV infection endorse a wide range of HIV/AIDS conspiracies because such beliefs can lead African Americans to be distrustful of HIV/AIDS related information and intervention efforts. Further, knowing the subgroup of the HIV-positive individuals most likely to endorse the beliefs in conspiracies about HIV/AIDS will help social workers, public health workers, health researchers, and practitioners develop efficient intervention programs for ethnic groups. Information on sociodemographic variables will be useful in HIV/AIDS prevention interventions that are culturally relevant. This is because lumping individuals of different identities and experiences into the same social category because they share a common route of infection and targeting uniform prevention programs to these social groupings will not be effective in stopping the spread of HIV/AIDS in communities of color.

As indicated above, several studies have noted that a significant percentage of African Americans hold conspiracy beliefs regarding HIV/AIDS (Bogart 2005;) For example, Herek and Capitanio (1994) found that 20% of African Americans agreed with the statement, “The government is using AIDS as a way of killing off minority groups” compared to 4% of whites. Lower levels of education and income were associated with the belief that the government is using AIDS as a way of killing off the minority groups.

Klonoff and Landrine (1999) surveyed Black adults in San Bernardino County, California and found that 14% of their respondents agreed, and 12% somewhat agreed, with the statement “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out Black people.” Respondents who had higher levels of education (i.e., college versus high school graduates) were most likely to agree with this statement. This contradicts Herek and Capitanio’s findings. Parsons, Simmons, Shinhoster, and Kilburn (1999) found that almost 70% of their respondents did not believe that the government is telling the truth about AIDS, and more than 25% agreed that AIDS was “intended to wipe Blacks off the face of the earth.”

Whetten et al. (2006) and her associates interviewed a sample of 611 HIV-positive individuals in 5 states of the deep south (North Carolina, South Carolina, Georgia, Alabama, and Louisiana). More than 25% of the respondents believed that the government created AIDS to kill minorities, and more than 50% believed that a significant amount of information about AIDS is withheld from the public. Though this study is useful in pinpointing the influence of conspiracy beliefs on health service use, the researchers did not examine a full range of conspiracy beliefs among African Americans with HIV infection.

Overall, prior research findings have shown the prevalence of conspiracy beliefs among African Americans in general (Parsons, Simmons, hinhoster, and Kilburn (1999). However, the degree to which such beliefs are common among HIV-positive African Americans has not received much empirical attention. Research assessing the relationship of conspiracy beliefs to sociodemographic variables among HIV-positive African Americans is very important for understanding how such beliefs may be barriers to HIV/AIDS prevention and treatment efforts within the black communities. In the present study, I extend the horizons of previous studies by examining the relationship between sociodemographic variables and endorsement of HIV/AIDS conspiracy beliefs among a sample of African Americans that are HIV-positive living in Black Belt Counties of Alabama one of the nation’s poorest regions.

METHODS

The Study Site

The study area, Alabama’s Black Belt, is a region where most of the African American Alabamians live. While there is a distribution of African Americans across Alabama, many continue to be concentrated in the southern portion of the state called the Black Belt. Black Belt as used in this work designates the counties where African Americans outnumber the whites, that is the density of black people. The region is one of the poorest in the nation and the majority of the residents are welfare dependent. The Black Belt with its higher than average percentage of African Americans (about 80%) is home to persistent poverty, poor employment, unemployment, limited education, poor health, Temporary Assistance for Needy Families (TANF) recipients, single parenthood and heavy dependence on public assistance programs (Zekeri 2020). The Black Belt is, indeed, a unique, disadvantaged region in the south.

Sample and Data Collection

The present qualitative and quantitative studies were part of a larger longitudinal project that is examining HIV/AIDS, Food Insecurity and poverty in Alabama’s Black Belt Counties. The study started in summer 2005 at an AIDS Outreach Organization in Alabama that provides medical and social support services to HIV-positive persons in Southeast Alabama.

For confidentiality purposes, only the staff of the AIDS Outreach informed the patients of the opportunity to participate in the study. The Adherence Nurse gave the questionnaire to patients and they completed the survey on a voluntary basis in a private room within the clinic. I obtained verbal informed consent prior to participants filling out the survey. Each patient was given a $15 Wal-Mart gift card after completing the questionnaire. The study protocol was approved by the human subjects review board of Tuskegee University. This sub-analysis focused the 256 (114 females and 142 males) African Americans who completed the questionnaire.

Measures

HIV/AIDS Conspiracy Beliefs

I adapted the conspiracy beliefs in Table 1 from previous studies (Zekeri 2009; 2018; 2019). Respondents were instructed to recorded their agreement with 10 statements capturing HIV/AIDS conspiracy theories (for example, “A lot of information about AIDS is being held back from the public,” “HIV is a manmade virus,” “AIDS is a real public health threat,” “There is a cure for AIDS, but it is being withheld from the poor,” “AIDS is a form of genocide against blacks,” “The government is not telling the truth about AIDS,” and “AIDS was created by the government to control the black population.”) The scale was from 1(disagree strongly) to 5 (agree strongly). The items were averaged and combined into one overall scale with higher scores indicating greater endorsement of HIV/AIDS conspiracies (Cronbach’s alpha = 0.89). We reverse-scored “The government is not telling the truth about AIDS” before including it in the scale.

Table 1.

Characteristics of Patients (N = 256)

	n	Percent
Gender
Male	142	55.5
Female	114	44.5
Marital Status
Single	150	58.6
Married	47	18.4
Living with a partner	21	8.2
Separated	13	5.1
Divorced	25	9.8
Educational Attainment
Did not graduate from High School	63	24.6
Completed High school	76	29.7
Some College or Vocational school	81	31.6
Completed a College Degree	35	13.7
Age
0–21	51	19.9
22–34	91	35.5
35–63	114	44.5

Sociodemographic Variables

Patients were asked questions to assess their gender, educational attainment, marital status, and age. Gender is sex of the respondent (1 = male and 2 = female). Educational attainment was measured by four categories: (1) did not graduate from high school; (2) completed high school; (3) some college or vocational school; (4) completed college. Education was dichotomized into “no high school” versus “high school and college graduates.” Age is age of the respondent in years. Age was dummy coded as young (18–34) and old (35–63) for the analysis.

Statistical Analyses

Analyses to determine whether endorsement of conspiracy beliefs varied by sociodemoghraphic variables were performed using the SPSS software version 14 (SPSS Inc, Chicago, Illinois) for Windows (Microsoft Corp, Redmond, Washington). Multiple linear regression analyses assessing the relationship between each of the sociodemographic variables to conspiracy beliefs scale were performed for the overall sample and by gender. The estimation of the probability that an association is not due to chance was based on chi-square statistics. A significance level of 0.05 was used for all analyses.

RESULTS

Sample Characteristics

The sample is heterogeneous in terms of socio-demographic characteristics (Table 1). Of the 256 respondents, 55.5% were men. Over half were not married, and only 18.4% were married at the time of the study. A substantial proportion were 35 years or older. Almost a third had some college or vocational education, and 29.7 had a high school diploma.

Conspiracy Beliefs

Results in Table 2 indicate that many patients endorsed conspiracy beliefs about HIV/AIDS. For example, more than half (68.4%) somewhat or strongly believed that, “A lot of information about AIDS is being held back from the public,” and 51.2% somewhat or strongly endorsed the statement that “HIV is a manmade virus,” while 55.1% agreed that “there is a cure for AIDS, but it being withheld from the poor.” Moreover, almost 88% somewhat or strongly agreed that, “AIDS is a real public health threat,” and 40.2% believed that “AIDS was produced in a government laboratory.” About one-third subscribed to the notion that “AIDS is a form of genocide against Blacks” (29.7%) and some 27.7% of the respondents said that “AIDS was created by the government to control the black population.” Regarding treatment-related conspiracy beliefs, over one-third (35.6%) somewhat or strongly agreed that “people who take the new medicines for HIV/AIDS are human guinea pigs for the government,” while 29.9% somewhat or strongly endorsed the statement that “the medicine that doctors prescribe to treat HIV is poison.” In the bivariate analysis, gender was not significantly related to conspiracy beliefs about HIV/AIDS.

Table 2.

HIV/AIDS Conspiracy Beliefs Endorsed by Patients Overall and by Gender (N = 256)

	% Agreeing Somewhat or Strongly
	Overall (n=256)	Men (n=142)	Women (n=114)	X2
HIV/AIDS Conspiracy Beliefs
A lot of information about AIDS is being held back from the public	68.4	70.3	69.0	8.10
HIV is a manmade virus.	51.2	54.2	50.6	1.98
AIDS is a real public health threat	87.9	89.8	87.4	2.14
AIDS is a form of genocide against blacks.	29.7	27.2	35.6	3.24
The government is not telling the truth about AIDS	47.3	44.9	48.2	7.25
AIDS was created by the government to control the black population.	27.7	28.9	29.9	3.77
There is a cure for AIDS, but it is being withheld from the poor	55.1	50.1	64.3	6.15
The medicine that doctors prescribe to treat HIV is poison	26.9	28.1	29.8	.54
People who take the new medicine for HIV are human guinea pigs for the government	35.6	38.1	34.5	.67
AIDS was produced in a government laboratory	40.2	46.6	37.9	5.54

Significant values are based on X² tests between women’s and men’s frequency distributions of the 5 category responses to each item (disagree strongly, disagree somewhat, no opinion, agree somewhat, agree strongly), df = 4.

Relationships of Sociodemographic variables to HIV/AIDS Conspiracy Beliefs

In the overall sample and among men, endorsement of HIV/AIDS conspiracy beliefs was related to education and age (Table 3). In contrast, only education was a significant predictor of endorsing HIV/AIDS conspiracy among women. This set of sociodemographic variables explained 13% of the variation in HIV/AIDS conspiracy beliefs in the total sample, 14% among men and 13% among women.

Table 3.

Multivariate sociodemographic predictors of beliefs in HIV/AIDS conspiracies

Sociodemographic	Ovarall (N=205)	Men (N=118)	Women (N=87)
Variables	Beta	Beta	Beta
Male Gender	.043	-----	-----
High School/College	−.321**	−.311**	−.332*
Married/Living with a partner	−0.50	.027	.−096
Age (ref. group >34Years)	.203**	.215**	.170
Model R2	.13	.14	.13

^*p < 0.05

^**p < 0.001

Qualitative Findings

Focus group discussions suggested that conspiracy beliefs can be important barriers to quality of life and infection control among HIV-positive individuals. Conspiracy beliefs can reduce medication adherence. Some patients miss their medications because they think it is poisonous. This can affect the viral suppression that under spins optimal health for HIV-positive individuals. Therefore, conspiracy belief as a correlate of antiretroviral success must be addressed by HIV clinicians.

Adherence to treatment

During the interviews, I found that the consequences of conspiracy beliefs can affect adherence to treatment. Some patients indicated that disbelief in medical white people was an overarching barrier to adherence to treatment. Some said that because some of their HIV medicines require taking them with food, they skip taking them when they don’t have food. “Susan, a 40 year old woman frankly told of various time she skipped her medication because she has no belief in them. “I usually don’t take my many medicines because I do not trust them. The medicines will make you sick in the stomach and they can kill you. Therefore, I do not take my medicines regularly as prescribed.”

DISCUSSION

The objectives of the present study were to measure the extent to which conspiracy beliefs about HIV/AIDS were endorsed among African-American patients with HIV infection and to examine whether conspiracy beliefs are more concentrated among some subgroups of patients with HIV infection than others. Consistent with previous research (Hutchinson et al 2007; Parsons 2021), many of the patients endorsed HIV/AIDS conspiracy beliefs. More extreme beliefs related to genocidal and medication related conspiracies were endorsed at sizeable rates. In this rural sample, 30.7% somewhat or strongly believed that “AIDS is a form of genocide against blacks,” and 36.6% somewhat or strongly agreed that “People who take the new medicine for HIV are human guinea pigs for the government.” These results resemble those of previous studies in the African American population. For example, Klonoff and Landrine (1999) in their survey of blacks in California found that 12% of their respondents somewhat agreed that “HIV/AIDS is a manmade virus that the federal government made to kill and wipeout black people.” Herek and Capitanio found that 20% of the African American in their studies endorsed the belief that “The government is using AIDS as a way of killing off minority groups.” In a similar vein, Bogart and Thornbun found that 43.6% of African Americans aged 15 to 44 years somewhat or strongly believed that “people who take the new medicines for HIV/AIDS are human guinea pigs for the government.” Our results support the findings of previous studies, that among HIV/AIDS positive African Americans, HIV/AIDS conspiracies may be a barrier to HIV/AIDS prevention and treatment efforts.

The sociodemographic variables as a set had a very small effect on African Americans with HIV infection endorsement of HIV/AIDS conspiracy beliefs. Education is significantly related to beliefs in conspiracies in all analyses (dealing with males and females separately). These findings are similar to the research by Bogart and Thorburn but contrary to Parsons (2021) findings that “Educational level of the HIV+ African American participants in 2000/2001 was not related to either belief in the malicious intent of HIV/AIDS as genocide.” Taken in the context of previous studies which have documented the impact of education on attitudes, the findings of differences between low level and higher levels of education is noteworthy and suggest that the liberalizing effect of education on individual attitudes should be acknowledged in HIV/AIDS prevention and treatment messages in African American communities. Although no previous research found a statistically significant relationship (Parsons 2021), age was statistically associated with stronger endorsement of HIV/AIDS conspiracy beliefs in the analyses of the whole sample and that of men as a subgroup. This is contrary to Parsons (2021) finding that “bivariate analyses indicated that the age of the respondents (year of birth, from earliest to most recent) was not related to either of the HIV rumors.”

Implications for HIV/AIDS Prevention and Treatment

Overall, these findings suggest that HIV/AIDS conspiracy beliefs among African Americans must be acknowledged and addressed in a culturally tailored HIV/AIDS prevention and education programs. This is because these conspiracy beliefs may be a barrier to HIV prevention and treatment efforts to halt the epidemic in African American communities where it is taking a terrible toll. This is particularly the case for less educated African Americans who are more likely to endorse conspiracy beliefs. This subgroup may be suspicious of HIV prevention and treatment information distributed by the US government and the public health system. For example, HIV-positive African Americans who endorsed treatment-related conspiracy beliefs (e.g., “people who take the new medicine for HIV/AIDS are human guinea pigs for the government”) may be less likely to adhere to antiretroviral therapies and prevention messages. It is unlikely that the less educated HIV-positive African Americans who believe the government created HIV will listen to the government’s warnings and take recommended treatments or come for testing. Public health officials working against the spread of HIV/AIDS must acknowledge and address the conspiracy beliefs common in African American communities.

To be useful, HIV/AIDS prevention messages addressing conspiracy beliefs may need to be delivered by trusted members of African American communities. Whenever possible, African American professionals from local health departments and community-based organizations are to be used to present HIV/AIDS education because it may foster the trust of African Americans. Such community-based and peer-delivered intervention messages may reduce risky sexual behaviors. Furthermore, health educators or public health officials working against the spread of HIV/AIDS must demonstrate both openness and sensitivity to questions about conspiracy beliefs and mistrust prevalent in the African American communities. This will help in understanding the historical roots and social context from which such questions arise. Conspiracy beliefs are not unique to HIV/AIDS alone but related to broader beliefs about conspiracies with the United States society as a whole such as family planning and drugs. As Bogart and Thorburn put it “to obtain the trust of black communities, government and public health entities need to acknowledge the origin of conspiracy beliefs openly in the context of historical discrimination”2 213–218.

Limitations of the study

The study has some limitations. The sample size is small. Additional research on these issues with a larger sample is needed to understand the breadth and complexity of beliefs in conspiracies about HIV/AIDS and relationships to sociodemographic variables. Place of residence was not considered in this study. Future research is needed to examine the contribution of this important variable to conspiracy beliefs. We want to know if there are differences among African American in rural and urban areas with regard to HIV/AIDS conspiracy beliefs.

In sum, it is recommended that all those involved in the battle against HIV/AIDS in African American communities (individuals, community organizations, and government agencies) must give special consideration to prevention and treatment efforts that will significantly reduce the incidence and prevalence of HIV/AIDS among African Americans in the Deep South. So, they should aggressively seek and identify subgroups (e.g., less educated, young African Americans) and to target social factors that enhance HIV/AIDS in these sub-groupings.

The present analysis supports the validity of continuing to explore the link between sociodemographic variables and HIV/AIDS conspiracy beliefs. In this sample, there was evidence of significant relationships between education, age and HIV/AIDS conspiracy beliefs. Many questions, however, remain unanswered. Do the relationships found for this sample of HIV-positive African Americans, who live in Alabama, hold for other groups in the population? Do the association between education and HIV/AIDS conspiracy beliefs differ by religion, geographical region, or rural-urban residence? Additional research, focusing on other ethnic groupings and other geographic areas is needed to address these questions.