Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South

September 17, 2020

September 17, 2020 - For Black women in the southern United States, mistrust of the health care system that is grounded in structural and systemic racism is a key factor affecting participation in HIV prevention and treatment services, reports a study in the September/October issue of The Journal of the Association of Nurses in AIDS Care(JANAC). The official journal of the Association of Nurses in AIDS Care, JANAC is published in the Lippincott portfolio by Wolters Kluwer.

"[Our] results indicate that there are barriers to the utilization of health services that are grounded in personal experiences, historical mistrust for the health care system and systemic racism," according to the qualitative study by Schenita D. Randolph, PhD, MPH, of Duke University School of Nursing and colleagues. "HIV programs serving Black women should include conversations around structural racism and trust for both providers and patients."

"Dr. Randolph's findings are critical because they demonstrate women's own views of the critical and sometimes subtle ways in which systemic racism can have dramatic effects on African-American women's health through multiple pathways," said Dr. Carol Golin, Professor of Medicine and Public Health at the University of North Carolina at Chapel Hill. "This suggests that working to dismantle racism is a fundamental step that is needed to fully address health disparities." Dr. Golin was Principal Investigator of the community-based parent study in which the data were collected.

New Insights on Obstacles to Black Women's Participation in HIV Care

Disparities in HIV risk are an important public health issue for Black women, particularly in the South. "Black women have nearly 20 times the risk of white women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States," according to the authors.

In a previous study, authors identified Black women's perceptions of structural racism and discrimination, and medical mistrust, as critical factors in the development of HIV prevention programs and interventions. The new study further explored those perspectives through a series of focus groups with African-American women living in low-income housing communities in one small city in the South.

Although they did not use those exact terms, the participants consistently communicated that the concepts of structural racism and discrimination, and medical mistrust, had a significant impact on their health care decisions and participation. From the focus group discussions, four subthemes emerged: "These findings support the importance for health care providers, as well as researchers, to be aware of systematic racism and structural discrimination that may be overt or covert in our health care systems," Dr. Randolph and coauthors write. They note that the focus group participants voiced a strong preference for HIV-related messaging and programming to be delivered by "trusted individuals or gatekeepers" in the community, whom they viewed are more relatable than health care providers. The findings also highlight the need for "careful attention to interpersonal relationships and communication in the clinical encounter with Black women."

"Findings on the understanding of Black women's skepticism of medical providers and systems reinforced and expanded our view of the importance of addressing these trust issues in future HIV prevention efforts with this population," the researchers write. "More importantly," Dr. Randolph comments, "findings expanded our view of the importance of addressing how our systems that are grounded in historical racism, contribute intentionally or unintentionally to the inequities of care among Black women."

Dr. Randolph and coauthors conclude: "This long history will require that critical conversations about structural and systemic racism and health take place to begin breaking deeply ingrained cycles of discrimination."
-end-
Click here to read "How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study."

DOI: 10.1097/JNC.0000000000000189

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About JANAC

The Journal of the Association of Nurses in AIDS Care(JANAC) is a peer-reviewed, international nursing journal that covers the full spectrum of the global HIV epidemic, focusing on prevention, evidence-based care management, interprofessional clinical care, research, advocacy, policy, education, social determinants of health, epidemiology, and program development. JANAC functions according to the highest standards of ethical publishing practices and offers innovative publication options, including Open Access and prepublication article posting, where the journal can post articles before they are published with an issue.

About the Association of Nurses in AIDS Care

Since 1987, the Association of Nurses in AIDS Care (ANAC) has been the leading nursing organization responding to HIV/AIDS. The mission of ANAC is to foster the professional development of nurses and others involved in the delivery of health care for persons at risk for, living with, and/or affected by the human immunodeficiency virus (HIV) and its co-morbidities. ANAC promotes the health, welfare and rights of people living with HIV around the world.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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