Exploring lack of trust in care providers and the government as a barrier to health service use.

OBJECTIVES: We examined associations between trust of health care providers and the government and health service use and outcomes. METHODS: Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers. RESULTS: Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible. CONCLUSIONS: Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.

Duke Scholars

Author Kathryn Whetten Sanford School of Public Policy

Author Jan Ostermann Duke Global Health Institute

Author Nathan Maclyn Thielman Medicine, Infectious Diseases

Author Marvin Stanley Swartz Psychiatry, Child & Family Mental Health & Community Psychia ...