Medical Mistrust, Social Networks, and Disparities in HIV Care Among Blacks

描述（由申请人提供）：非洲裔美国人感染艾滋病毒的情况比白人更糟，在艾滋病毒护理连续体的所有点上都存在巨大的种族/民族差异。与感染艾滋病毒的白人相比，感染艾滋病毒的非洲裔美国人参与和坚持护理的程度较低，接受最先进的抗逆转录病毒治疗（art）的可能性较小；那些接受抗逆转录病毒治疗的人不太可能坚持到足以使治疗有效的水平。拟议的5年项目侧重于与艾滋病毒有关的医疗不信任（例如，误解、阴谋，如艾滋病毒是一种种族灭绝形式）作为艾滋病毒护理和治疗行为的障碍。具体而言，该项目将研究社会背景，特别是社会网络（即围绕个人的社会关系的星座）如何影响与艾滋病毒相关的医疗不信任的传播，进而影响感染艾滋病毒的非裔美国人的治疗行为。总共240名感染艾滋病毒的非洲裔美国人（120人未接受治疗，120人接受抗逆转录病毒治疗）将被随访12个月；将收集与艾滋病毒有关的不信任信念在社交网络上的流动数据，以及随着时间的推移艾滋病毒护理结果（参与护理，坚持抗逆转录病毒治疗）。该研究将与社区利益相关者合作，形成积极干预的概念，以确定创新的基于社会网络的解决方案，以改善治疗行为，并最终减少差异。具体目标是：(1)确定非裔美国人艾滋病相关信息的社会网络来源（即不信任、误解、阴谋和准确信息）；(2)研究与艾滋病毒不信任相关的社会网络特征与艾滋病毒治疗行为（参与护理、抗逆转录病毒治疗使用、抗逆转录病毒治疗依从性）之间的关系；(3)与社区利益相关者一起，利用研究结果确定新的干预方案，以解决非洲裔美国人感染艾滋病毒的不信任和改善艾滋病毒治疗行为。hiv相关的不信任被假设通过社会网络传播，并与特定的网络特征相关；假设与艾滋病毒相关的高度不信任的个体不太可能参与护理并坚持抗逆转录病毒治疗；社会网络的组成（如网络中的不信任程度）和结构（如网络成员的亲密程度）被预测与HIV治疗行为有关（例如，在不信任程度高的网络中，个体的不信任与依从性之间的关系会更大）。迄今为止，还没有研究使用社会网络方法来了解艾滋病毒相关信息的流动和艾滋病毒感染者之间的误解。

DESCRIPTION (provided by the applicant): African Americans with HIV fare worse than their White counterparts, with large racial/ethnic disparities at all points along the HIV care continuum. Compared to Whites with HIV, African Americans with HIV have lower levels of engagement and retention in care, and are less likely to be on state-of-the art antiretroviral treatment (ART); those on ART are less likely to be adherent at high enough levels for the treatment to be effective. The proposed 5-year project focuses on HIV-related medical mistrust (e.g., misconceptions, conspiracies such as that HIV is a form of genocide) as a barrier to HIV care and treatment behaviors. Specifically, the project will examine how social contexts, specifically, social networks (i.e., the constellation of social relationships surrounding an individual), may influence the spread of HIV-related medical mistrust, and in turn, affect treatment behaviors among African Americans with HIV. A total of 240 African Americans with HIV (120 not engaged in care, 120 on ART) will be followed over 12-months; data will be collected on the flow of HIV-related mistrust beliefs across social networks, as well as HIV care outcomes over time (engagement in care, adherence to ART). The research will conclude with active intervention conceptualization in partnership with community stakeholders in order to identify innovative social network-based solutions for improving treatment behaviors and ultimately, reducing disparities. The specific aims are: (1) To identify social network sources of HIV-related information (i.e., mistrust, misconceptions, conspiracies, and accurate information) among African Americans with HIV; (2) To examine the ways in which social network characteristics related to HIV mistrust are associated with HIV treatment behaviors across the HIV care continuum (engagement in care, antiretroviral treatment use, antiretroviral treatment adherence); and (3) Together with community stakeholders, to use study findings to identify novel intervention solutions to address mistrust and improve HIV treatment behaviors for African Americans with HIV. HIV-related mistrust is hypothesized to be spread through social networks and associated with specific network characteristics; individuals with high HIV-related mistrust are hypothesized to be less likely to be engaged in care and to be adherent to ART; and social network composition (e.g., level of mistrust in network) and structure (e.g., closeness of network members) are predicted to be related to HIV treatment behaviors (e.g., the relationship between mistrust and adherence will be greater for individuals in networks with high levels of mistrust). No research to date has used a social network approach to understanding the flow of HIV-related information and misconceptions among people with HIV.