Discrimination, distrust, and racial/ethnic disparities in antiretroviral therapy adherence among a national sample of HIV-infected patients.
OBJECTIVE
Although discriminatory health care experiences and health care provider distrust have been shown to be associated with health care disparities, little is known about their contribution to racial/ethnic disparities in antiretroviral therapy adherence. We therefore sought to assess the extent to which discriminatory health care experiences and health care provider distrust influence treatment-related attitudes, beliefs, and self-reported adherence in a national sample of HIV-infected patients.


METHODS
This secondary analysis used data from the HIV Cost and Services Utilization Study. We used structural equation modeling to identify pathways from minority status to adherence through discrimination, distrust, and treatment-related attitudes and beliefs.


METHODS
The sample was the 1886 participants who completed the baseline and 2 follow-up interviews and were prescribed antiretroviral therapy at the second follow-up interview (54% white, 28% black, 14% Hispanic, and 3% others).


RESULTS
Minorities were less likely to report perfect adherence than whites (40% vs. 50%, P < or = 0.001). Over one third (40%) of all participants reporting ever having discriminatory health care experiences since having HIV, and 24% did not completely or almost completely trust their health care providers. The effect of minority status on adherence persisted in the full model. More discrimination predicted greater distrust, weaker treatment benefit beliefs, and, in turn, poorer adherence. Distrust affected adherence by increasing treatment-related psychological distress and weakening treatment benefit beliefs.


CONCLUSIONS
The relationship between minority status and adherence was not fully explained by patient-level factors. Future studies should consider conceptualizing minority status as a contextual factor rather than predictor.
Thrasher
Angela D
AD
Center for Social Disparities on Health, School of Medicine, University of California, San Francisco, CA 94118, USA. thrashera@fcm.ucsf.edu
Earp
Jo Anne L
JA
Golin
Carol E
CE
Zimmer
Catherine R
CR
D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008913:Minority Groups; D010349:Patient Compliance; D011287:Prejudice; D044469:Racial Groups; D012959:Socioeconomic Factors; D035502:Trust