Consistent with prior research,10
we found that men and those with lower educational attainment were more likely to endorse conspiracy beliefs, as well as older individuals. We found that those individuals who believe HIV conspiracies were more likely to have taken an HIV antibody test. This finding may help explains the finding of Clark and colleagues12
that individuals who hold HIV conspiracy beliefs have a shorter period between infection and diagnosis. Despite the fact that holding these conspiracy beliefs suggests a distrust of governmental institutions, these results indicate that conspiracy beliefs are not an impediment to HIV testing. Consequently, interventions to increase HIV testing in high-risk communities may not require efforts to reduce conspiracy beliefs.
We did not find a significant relationship between risk behaviors for HIV and conspiracy beliefs. Other samples,4,11
however, have found that individuals who hold conspiracy beliefs also report more negative attitudes towards condoms, less consistent condom use, and a greater number of sex partners. As many individuals receive HIV tests in medical settings,15–17
their willingness to get HIV testing potentially provides an important contact with the health care system. Specifically, these visits provide a crucial opportunity to provide culturally sensitive HIV risk behavior education and interventions by health care providers who may earn or have earned the trust of individuals who have a mistrust of larger government and social institutions. Findings from a national survey indicate that many individuals do not recall receiving HIV counseling after receiving a HIV test, including among individuals at high risk of acquiring HIV,17
indicating that there is potential to expand the frequency and quality22
of counseling services to those receiving HIV tests.
For individuals in HIV care, holding conspiracy beliefs suggest a distrustfulness that could pose a barrier to treatment. Clinicians should be sensitive to the distrust of science among some patients. Consequently, emphasis on scientific findings may not be effective means of persuading patients of the need for safe injecting and safe sex practices or treatment adherence. The degree to which conspiracy beliefs influence HIV treatment and interventions requires further exploration.
While not a primary aim of the present analysis, our study with a sample of inner-city African Americans found that individuals with depression were more likely to have never been tested for HIV, in contrast with a national household sample that found depression was associated with having had an HIV test.18
This finding in a sample with high rates of risk behavior is concerning and merits further research. While HIV risk behaviors are associated with a greater likelihood of reporting HIV testing in samples of the general U.S. population,16,17
we found that injection drug use but not risky sex was associated with HIV testing in our sample. As a greater proportion of new HIV cases are accounted for by heterosexual transmission,1
this finding is also concerning and should be further investigated.
There are several limitations to the present study. Drug use, prison, and HIV test data were self-report. Moreover, we did not assess all factors that may have contributed to participants' HIV testing behaviors and to their beliefs about HIV. We also did not examine whether participants actually obtained their HIV test results or accurately understand the meaning of the HIV antibody tests. The degree to which conspiracy belief questions may be subject to reporting biases in survey data collected through face-to-face interviews is not known; however, the use of interviewers recruited from the local community likely had a positive effect on the comfort level for participants to report conspiracy beliefs. Data collection was cross-sectional, and the interpretation is subject to the usual limitations of cross-sectional data. Beliefs are not immutable, and it cannot be assumed that participants felt the same way regarding the origins of HIV at the time of assessment as they did when they received an HIV test. It is unlikely, however, that having an HIV test results in an increase in conspiracy beliefs, and seems more probable that their conspiracy beliefs influence their attitudes towards testing. Future research should explore the relationship of conspiracy beliefs with recency and frequency of HIV testing.
The rate of HIV testing (93%) was high in the present sample, even compared to other samples drawn from populations with high levels of risk behavior. For example, in a sample of inner-city African Americans in Chicago, approximately 75% reported having ever had an HIV test,2
and in a national sample 67.1% of those with a lifetime risk factor (including injection drug use or sex with an injection drug user) reported ever having an HIV test.18
The high rate of testing suggests that the findings have limited generalizability, as the relationship of testing with beliefs and other covariates may be very different for populations with lower rates of testing. However, while our findings may lack generalizablity, the present sample (inner-city African Americans with very high rates of injection drug use and inconsistent condom use) represents a population important to the study of conspiracy beliefs and HIV risk.
The unadjusted prevalence of never having had HIV testing of those who endorse conspiracy beliefs (4.0%) compared to those who do not (7.7%) indicate that, while those who hold these beliefs are significantly more likely to report testing, the difference between groups in the prevalence of testing is not large. The study also made use of a convenience sample of those willing to participate in research. This may result in an underestimate of the prevalence of these beliefs among low-income African Americans. It is possible that those individuals who have the greatest degree of mistrust for the government regarding HIV, such that they would be unwilling to participate in research, would have different attitudes toward HIV testing than those individuals who hold conspiracy beliefs but not strongly enough that it prevents them from participating in research activities.
The present study found that African American individuals in a low-income inner city community who endorse HIV conspiracy beliefs are more likely to have had an HIV test. Further research is needed to understand the consequences and causes of HIV conspiracy beliefs in minority populations.