Mostashari F, Blankenship K, Altice FL; International Conference on AIDS.

Int Conf AIDS. 1996 Jul 7-12; 11: 433 (abstract no. Th.D.5189).

AIDS Program, Yale School of Medicine, New Haven, CT. Fax: (203) 737-5143. E-mail: fmostash@biomed.med.yale.edu.

Issue: Lack of "trust" is often invoked as a barrier to the health care utilization of marginalized populations. An ideal setting in which to study this relationship may be correctional facilities, which house large numbers of disenfranchised (mostly injection-drug using) HIV+ individuals, in a setting where access to health care is uniform. We sought to develop a more thorough understanding of the attitudinal factors that affect HIV medication use among incarcerated HIV+ individuals, and in particular, the meaning and moment of health-care related trust. Project: Focus groups and indepth interviews with HIV+ inmates in 3 state prisons in Connecticut. Verbatim transcripts of the interviews were analyzed to identify concepts and themes regarding "trust" and HIV medication use. Results: The acceptance of HIV medication reflects a balance between the fear of side-effects (often promoted by HIV+ peers) and the hope of benefits (promoted by health care professionals and some peer advocates). The resolution of this decision is mediated by the balance of interpersonal trusts (e.g. "trust in physician" vs. "trust in peers"), but also, by a different aspect of health-related trust: "trust in society". The most important dimensions of "trust in physician" revolve around Confidentiality, Caring, and Expertise. "Trust in peers" appears to depend on Experience, Confidentiality, and Open-ness with their own HIV status. Dominant themes in "trust in society" are Greed, Genocide, and Omnipotence. Adherence to an HIV medication is strongly affected by the personal experience of perceived side-effects vs. perceived benefits (especially as reflected in T-cell count). Other attitudinal concepts that may influence medication adherence are 1) an illness model that warns against the "mixing of chemicals" between street drugs and medications, and 2) the belief that "stress is the killer" with daily medication use as a stressful reminder of HIV infection. Lessons Learned: This exploratory qualitative study suggests an important role for "trust in physician," "trust in peers," and "trust in society" on medication acceptance and adherence among HIV+ inmates. This methodology can be used to inform interventions aimed at creating a more effective - and trustworthy- health care system.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Confidentiality
• Connecticut
• Delivery of Health Care
• HIV Infections
• HIV Seropositivity
• Peer Group
• Prisoners
• Prisons
• Trust

Other ID:

• 96925435

UI: 102221334

From Meeting Abstracts