Medical Mistrust, Discrimination, and the Domestic HIV Epidemic

General medical mistrust and HIV-specific medical mistrust (i.e., conspiracy beliefs about HIV’s origin and treatment) stem from historical and ongoing experiences of structural and interpersonal discrimination, and contribute to racial/ethnic HIV disparities in the United States. Medical mistrust is more prevalent among people of color than White Americans and is associated with HIV prevention and treatment outcomes. We propose a multilevel model in which structural discrimination generally and healthcare specifically lead to the development, spread, and maintenance of medical mistrust in communities and social networks, which in turn affects HIV outcomes through a reluctance to engage with healthcare. Mistrust, conceptualized as a survival mechanism to cope with discrimination and to protect individuals from future mistreatment, can be a resilience resource that motivates individuals and communities to work toward structural change. Research is recommended on multilevel approaches that engage healthcare providers to address discrimination and empower communities to channel mistrust into advocacy.