| Abstract | Medical mistrust has emerged as a significant barrier to medication adherence among African Americans living with HIV. This study sought to determine whether the relationship between medical provider mistrust and antiretroviral therapy adherence is accounted for by beliefs that may be more amenable to change. African American men and women receiving antiretroviral therapy (N = 380) in a large southern US city completed computer-administered measures of health, antiretroviral therapy adherence, race-based medical provider mistrust, and medication necessity and concerns beliefs. Multiple mediation modeling showed that medical provider mistrust was associated with medication beliefs and antiretroviral therapy adherence. In addition, medication beliefs predicted antiretroviral therapy adherence. Based on 5000 bootstrap resamples, the indirect effects of medical provider mistrust on adherence via medication beliefs were significant, unstandardized b = -1.24, 95 percent confidence interval = -2.47 to -0.29; the indirect effect was significant for medication concerns beliefs, b = -1.10, 95 percent confidence interval = -2.33 to -0.21, but not medication necessity beliefs, b = -0.14, 95 percent confidence interval = -0.66 to 0.02. We conclude that medication concerns beliefs mediates the association between medical provider mistrust and antiretroviral therapy adherence. Interventions that directly elicit and address medication concerns may resolve intentional and unintentional antiretroviral therapy non-adherence even when patients mistrust medical providers. |
