HIV conspiracy theories associated with poorer condom attitude and use amongst African American men

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A significant proportion of African Americans agree with conspiracy theories about HIV, according to a study published in the February 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators also found that agreement with these conspiracy theories could be hampering HIV prevention efforts as, for African American men, stronger agreement with conspiracy theories was associated with more negative attitudes towards condoms and less consistent condom use.

Background to the study

Earlier research has previously suggested that a higher proportion of African Americans than white Americans endorse conspiracy theories about HIV. In one study, conducted in San Bernardino, California, over a quarter of black residents agreed with the belief that, “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people.” This distrust is thought to have its origins in historical and current racial discrimination in the US healthcare system, with the Tuskegee syphilis experiment, being a particularly well-known example.

HIV disproportionately affects African Americans, and identifying barriers to effective prevention efforts is a key concern for HIV prevention workers. Although the importance of addressing conspiracy theories in HIV prevention initiatives has been acknowledged by researchers, there has been very little research examining whether an endorsement of conspiracy theories translates into negative attitudes towards condoms and lower condom use.

Study design

Investigators conducted a cross-sectional, anonymous telephone survey involving 500 African Americans aged between 15 – 44.

Glossary

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

syphilis

A sexually transmitted infection caused by the bacterium Treponema pallidum. Transmission can occur by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores may be found around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth, but syphilis is often asymptomatic. It can spread from an infected mother to her unborn baby.

Individuals were asked about their sociodemographic characteristics, the strength of their black identity and religious beliefs, their perceived risk of HIV infection, their partnership status, their number of recent sexual partners, their history of sexually transmitted infections, their HIV conspiracy beliefs, and their attitudes towards, and use of, condoms.

HIV conspiracy beliefs were measured by asking individuals their agreement on a scale ranging from one (disagree strongly) to five (agree strongly) with 14 questions.

Demographics

In total, 45% of the study population was aged between 21 – 34, 65% were female, 51% had completed high school or less, 53% had an income of less than $35,000 per year, 37% were married or lived with their partner, 6% of men said that they had sex with other men, 17% reported multiple sexual partners in the past three months, 25% said that they had had a sexually transmitted infection in the past, and 36% said they consistently used condoms.

Agreement with conspiracy theories

A significant proportion of individuals endorsed conspiracy theories about HIV. Although less than 2% agreed that “doctors put HIV into condoms”, 43% endorsed the view that “people who take the new medicines for HIV are human guinea pigs for the government”, 48% agreed that “HIV is a man-made virus”, and 53% agreed with the statement that “there is a cure for AIDS, but it is being withheld from the poor”. However, 37% agreed that “the government is telling the truth about AIDS”, and 38% agreed that, “the medicines used to treat HIV are saving lives in the black community.”

The investigators noted, that men and women held different patterns of conspiracy beliefs, with men displaying a greater level of agreement with some beliefs than women (for example, “AIDS is a form of genocide against blacks”, 20% men agreed versus 12% women, p <0.05). Although they were around the midpoint, overall, men’s endorsement of conspiracy beliefs was stronger than womens (mean score 2.48 versus 2.21, p < 0.01).

Conspiracy beliefs and condom attitudes and use

Among men, conspiracy beliefs were significantly associated with negative attitudes towards condoms (p < 0.05), and inconsistent condom use (p < 0.01).

In secondary analysis the investigators tested the relationship between men’s endorsement of HIV conspiracy theories. They found that attitudes towards condoms reduced to statistical insignificance the relationship between conspiracy beliefs and condom use. A significant relationship still existed between condom attitudes and condom use (p < 0.001). However, the investigators note that the effects of HIV conspiracy beliefs between the models including and excluding condom attitudes was not large.

Investigator discussion

“Men held stronger conspiracy beliefs than did women,” write the investigators, “and endorsement of conspiracy beliefs was associated with more negative attitudes towards condoms and less consistent condom use among men but not among women.” The investigators believe that addressing HIV conspiracy theories could increase acceptance of information about the positive aspects of condoms, which could, in turn, lead to greater condom use.

The investigators conclude that HIV prevention initiatives targeted at African Americans should address conspiracy beliefs, and that these are likely to have most success if they address such beliefs in the “context of historical and current racial discrimination…to obtain the trust of black communities, government and public health entities need to acknowledge the origin of conspiracy theories openly in the context of historical discrimination as well as to collaboratively work to address current discrimination within the health care system. In this way, we can begin to overcome barriers, such as conspiracy beliefs, that are obstacles to the ready acceptance of prevention messages and the subsequent practice of safer sexual behaviors.”

References

Bogart LM et al. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?. J Acquir Immune Defic 38: 213 – 218, 2005.