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

描述(由申请人提供)：感染艾滋病毒的非裔美国人比他们的白人同龄人情况更差，在艾滋病毒护理连续过程中的所有点上都存在很大的种族/民族差异。与感染艾滋病毒的白人相比，感染艾滋病毒的非裔美国人的参与度和保留率较低，也不太可能接受最先进的抗逆转录病毒治疗(ART)；那些接受ART治疗的人不太可能被坚持到足够高的水平，以使治疗有效。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，误解和阴谋，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。具体地说，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。将对240名感染艾滋病毒的非裔美国人(120名不参与护理，120名接受抗逆转录病毒治疗)进行为期12个月的跟踪；将收集与艾滋病毒相关的不信任信念在社会网络中的流动情况以及一段时间内艾滋病毒护理结果(参与护理、遵守抗逆转录病毒治疗)的数据。这项研究将以与社区利益攸关方合作的积极干预概念为结束，以确定基于社会网络的创新解决方案，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毒携带者中艾滋病毒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有关的社会网络特征与整个艾滋病毒护理连续体系中的艾滋病毒治疗行为(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)相关的方式；以及(3)与社区利益攸关方合作，利用研究结果确定新的干预解决方案，以解决不信任问题并改善非裔美国艾滋病毒感染者的艾滋病毒治疗行为。与艾滋病毒相关的不信任被假设通过社交网络传播，并与特定的网络特征相关联；与艾滋病毒相关的高度不信任的个人被假设为不太可能从事护理和遵守ART；以及社会网络的组成(例如，对网络的不信任程度)和结构(例如，网络成员的亲密度)被预测与艾滋病毒治疗行为有关(例如，对于高度不信任的网络中的个人，不信任与坚持之间的关系将更大)。到目前为止，还没有研究使用社交网络方法来了解艾滋病毒携带者中与艾滋病毒相关的信息和误解的流动。

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.