Discrimination, Distrust, and Racial/Ethnic Disparities in Antiretroviral Therapy Adherence by HIV+ Patients Public Deposited

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  • March 20, 2019
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  • Thrasher, Angela D.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Little is known about the contribution of discriminatory healthcare experiences and healthcare provider distrust to racial/ethnic disparities in antiretroviral adherence among HIV+ patients. Among participants of the national HIV Cost and Services Utilization Study who completed three surveys over 12 months (n = 2267), I examined potential factors associated with discriminatory healthcare experiences and healthcare provider distrust. Among participants who reported antiretroviral therapy use at the last survey (n = 1911), I used structural equation modeling to test direct and indirect relationships among racial/ethnic minority status, discriminatory healthcare experiences, healthcare provider distrust, and medication adherence. I conceptualized minority status as a proxy for experiences with, and expectations about, racism in medicine. Attribution theory and models of antiretroviral therapy adherence informed the hypothesized relationships. Almost half (41%) the participants reported experiencing discrimination in healthcare settings, while few participants reported distrust of their healthcare providers. Factors associated with discrimination were being white (an unexpected finding), younger age, some college education, earlier HIV diagnosis, poorer self-reported physical health, AIDS diagnosis, ever having a CD4 count < 200, any illicit drug use in the past year except heroin or cocaine, and less social support. Factors associated with distrust were younger age, some college education, poorer self-reported physical and mental health, higher viral load, drug use in the past year, less social support, and more discrimination. In the full structural equation model, the direct effect of minority status on adherence remained despite the presence of hypothesized mediators. The magnitude of indirect effects via discrimination, distrust, and medication efficacy beliefs was negligible, and their sum was not statistically significant. The effect of discrimination on adherence was entirely indirect via greater distrust and weaker medication efficacy beliefs. Greater distrust was unexpectedly associated with better adherence. Distrust indirectly affected adherence via participants' psychological distress about taking antiretroviral therapy and weaker medication efficacy beliefs. These findings offer partial support for the relationships posited among experiences and expectations of racism (as racial/ethnic minority status), discriminatory healthcare experiences, healthcare provider distrust, and antiretroviral therapy adherence. Future researchers should consider models with minority status as a contextual influence upon the hypothesized relationships.
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  • Earp, Jo Anne L.
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