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For black women in the southern US, distrust of the health system, which is based on structural and systemic racism, is a key factor in participating in HIV prevention and treatment services, reports a study in the September / October issue of the Journal of the Association of Nurses in AIDS Care (JANAC).
"(Our) results show that there are barriers to the use of health services based on personal experience, historical distrust of the health system and systemic racism," says the qualitative study by Schenita D. Randolph, Ph.D. , MPH, Duke University School of Nursing and colleagues. "HIV programs for black women should include discussions about structural racism and trust for both providers and patients."
"Dr. Randolph's findings are critical because they demonstrate women's own views of the critical and sometimes subtle ways that systemic racism can have dramatic effects on the health of African American women in a number of ways," said Dr. Carol Golin, professor of medicine and public health at the University of North Carolina at Chapel Hill. "This suggests that combating racism is a fundamental step needed to completely eradicate health inequalities." Dr. Golin was the Principal Investigator of the community-based parenting study in which the data was collected.
New insights into barriers to black women's participation in HIV care
Differences in HIV risk are a major public health issue for black women, especially in the South. "Black women have nearly 20 times the risk of white women becoming infected with HIV, and life-long HIV risk is greatest for people in the southern United States," the authors say.
In a previous study, the authors identified perceptions of structural racism and discrimination by black women and medical distrust as critical factors in the development of HIV prevention programs and interventions. The new study examined these perspectives through a series of focus groups with African American women living in low-income shared apartments in a small town in the south.
While not using these exact terms, participants consistently shared that the concepts of structural racism and discrimination, as well as medical distrust, had a significant impact on their decisions and participation in health care. Four sub-topics emerged from the focus group discussions:
- Decreased reliance on health care advice and instructions. Based on their experience, some women have found that healthcare professionals give incomplete or even incorrect medical information to black patients. They also found some medical institutions to be more trustworthy or receptive to black patients than others.
- Systems and structures that discriminate against black women. "Institutional and systematic regulations" – particularly measures related to living in low-income housing – contributed to distrust of the health system. Participants found that the combination of black and woman added "a layer of challenges" to access to health care. The women felt that "there are little to no resources in the community to access affordable health care".
- Lack of effective communication. The women reported experiences of poor health communication, including misinformation, and were not given details of the care provided. Some women reported effective communication with providers – which shows that taking the time to develop good communication and relationships can lead to improved health behaviors.
- Need for empowerment in clinical encounters. The perceived racist bias in dealing with health care providers motivated the women to stand up for their rights. They felt they should be able to question health care recommendations and request more information from providers.
"These results support the role of health care providers and researchers in systematic racism and structural discrimination, which can be overt or covert in our health systems," write Dr. Randolph and co-authors. They find that focus group participants have expressed a strong preference for HIV-related news and programming from "trusted people or gatekeepers" in the community who they believe are more reliable than healthcare providers. The results also highlight the need for "careful attention to human relationships and communication in clinical encounters with black women".
"The findings on understanding black women's skepticism about medical providers and systems have strengthened and broadened our view of the importance of addressing these confidence issues in future HIV prevention efforts with this population," the researchers write. "More importantly," comments Dr. Randolph, "the results have broadened our view of the importance of examining how our systems, based on historical racism, intentionally or unintentionally contribute to inequalities in the care of black women."
Dr. Randolph and co-authors conclude, "This long story requires critical discussions about structural and systemic racism and health in order to break deeply ingrained cycles of discrimination."
Racial discrimination can affect how African Americans are perceived
Randolph, Schenita D., et al. How Perceived Structural Racism and Discrimination, and Medical Mistrust in the Health System Affect Participation in HIV Health Services for Black Women in the United States in the South: A Qualitative, Descriptive Study. Journal of the Association of Nurses in AIDS Care. September-October 2020 – Volume 31 – Issue 5 – pp. 598-605 DOI: 10.1097 / JNC.0000000000000189
Wolters Kluwer Health
Medical distrust due to structural and systemic racism is affecting HIV care for black women in the southern United States (2020, Sep 17).
accessed on September 17, 2020
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