Race-based medical mistrust, medication beliefs and HIV treatment adherence: test of a mediation model in people living with HIV/AIDS

J Behav Med. 2016 Dec;39(6):1056-1064. doi: 10.1007/s10865-016-9767-1. Epub 2016 Jul 9.


Race-based medical mistrust significantly predicts non-adherence to antiretroviral therapy (ART) in people living with HIV. The current study builds on previous research that shows beliefs about medication necessity (i.e., "My medicines protect me from becoming worse") and concerns (i.e., "Having to take my medicines worries me") mediate the association between race-based medical mistrust and medication adherence. Racial and ethnic minority men and women living with HIV and receiving ART (N = 178) in a southern US city completed computerized measures of demographic and health characteristics, telephone interviews of race-based medical mistrust and medication beliefs, and unannounced phone-based pill counts for ART adherence. Multiple mediation modeling showed that medical mistrust is related to medication necessity and concerns beliefs and ART adherence. Furthermore, medication necessity beliefs predicted ART adherence. The indirect effect of medical mistrust on adherence through medication necessity beliefs was also significant. Results confirm that medication necessity beliefs, although not concerns beliefs, mediate the association between medical mistrust and ART adherence. Medication necessity beliefs offer a viable target for interventions to improve ART adherence in the context of mistrust that patients may have for medical providers and health care systems.

Keywords: HIV/AIDS; Medical mistrust; Medication adherence; Medication beliefs.

MeSH terms

  • Adult
  • Black or African American / psychology*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • Health Knowledge, Attitudes, Practice*
  • Hispanic or Latino / psychology*
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Trust / psychology*