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Primary Submission Category: Social/relational factors
Examining the Influence of Domains of Trust in Decision-Making Points for HIV Prevention and Care Among Racial and Sexual Minoritized Individuals
Authors: Ananya Bhaktaram, Zoe Hendrickson, Lauren Dayton, Carl Latkin,
Presenting Author: Ananya Bhaktaram*
Background: Previous studies have shown that social (e.g., social networks, interpersonal relationships), structural (e.g., stigma, discrimination, transportation access), and contextual factors (e.g., neighborhood environments) influence care-seeking decision-making for multiply marginalized individuals. Many studies have examined the role of medical or institutional distrust as a contributor to underutilization of services by marginalized populations. Trust is a multi-dimensional construct, but few studies have examined how different domains of trust (e.g., interpersonal, institutional, generalized trust, and calculative trust) may interact to contribute to disparities in HIV prevention and care.
Methods: Between March 2024 and March 2025, 20 integrated mapping interviews (IMIs) were conducted with racially and sexually minoritized men in Baltimore, MD. IMIs produced participant-drawn visual maps connected to rich qualitative descriptions, yielding geospatial data on where participants sought care and qualitative descriptions of their experiences and attitudes toward different health care organizations. Emergent themes were analyzed using a thematic approach.
Results: Many participants discussed that privacy concerns (institutional and social or community mistrust) meant that while access to services remained important, people did not necessarily want services to be located within their neighborhoods. Participants who reported previous negative experiences with primary care providers (interpersonal distrust) were more likely to prioritize patient-physician concordance even if it meant traveling greater distances. Additionally, participants discussed how intersectional forms of stigma impacted different domains of trust and influenced decisions to engage in HIV prevention.
Conclusion: Future research should examine the decision-making cascade of how multiply marginalized individuals engage in HIV prevention and care.