title: Exploring lack of trust in care providers and the government as a barrier to health service use.
abstract: OBJECTIVE
  We examined associations between trust of health care providers and the government and health service use and outcomes.
  
  
  METHODS
  Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers.
  
  
  RESULTS
  Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible.
  
  
  CONCLUSIONS
  Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.
authors.affiliation: Center for Health Policy, Box 90253, 125 Old Chemistry Bldg, Durham, NC 27708, USA. k.whetten@duke.edu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.forename: Jane
authors.initials: J
authors.lastname: Leserman
authors.forename: Rachel
authors.initials: R
authors.lastname: Whetten
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Nathan
authors.initials: N
authors.lastname: Thielman
authors.forename: Marvin
authors.initials: M
authors.lastname: Swartz
authors.forename: Dalene
authors.initials: D
authors.lastname: Stangl
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D005260:Female; D006076:Government; D006679:HIV Seropositivity / Q000208:ethnology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000523:psychology; D011369:Professional-Patient Relations; D035502:Trust; D014481:United States