COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

Abstract

Background: Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. Methods: Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. Results: Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = −5.19 (2.08), P = 0.02]. Discussion: To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

“…The same survey also found that over half (52%) of the survey respondents believed that the U.S. healthcare system "always/often" treats people unfairly based on their race or ethnic background. A recent study by Bogart et al (2021) [125] also found substantial issues of mistrust surrounding COVID-19 vaccines and treatment among HIV-positive Blacks. Their study findings combined with experience and expertise regarding issues of medical mistrust by U.S.…”

Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective

“…Due to historical and current interpersonal and systemic racism in the U.S., much of which is propagated at a government and policy level, racial differences in vaccine trust and lower levels of trust among African Americans may also be observed ( Quinn et al, 2016 ; Solomon and Castro, 2019 ; Feagin, 2014; Bogart et al, 2020 ; Ferdinand and Reddy, 2020). For example, an online survey on COVID-19 vaccine attitudes among U.S. adults from Marks, 2020 found that vaccine acceptability differed significantly by sociodemographic characteristics such as race ( Reiter et al, 2020 ).…”

COVID-19 Vaccine Hesitancy among French People Living with HIV

“…While there is considerable enthusiasm and anticipation for the COVID-19 vaccine, little is known about vaccine hesitancy, especially for COVID-19, in vulnerable French populations. A vulnerable population, as people living with HIV, presents poorer COVID-related outcomes compared to those without HIV [ 28 , 29 , 30 ]. Currently, little evidence exists on how HIV infection affects the risk of poor outcomes from COVID-19 [ 31 ].…”