Medical mistrust of health systems as a moderator of resilience and self-reported HIV care engagement in Black and Latinx young adults living with HIV.

OBJECTIVE

To study resilience and its association with HIV care engagement in a sample of young adult Black and Latinx people living with HIV (PLWH) in the United States and to test if a systems-level barrier, medical mistrust, would moderate the resilience-engagement association.

METHOD

Between April and August 2021, we recruited participants through social media and dating apps ( = 212) and verified age and HIV status through a review process of digital text-messaged and emailed photos. Participants completed a one-time online survey consisting of the Connor-Davidson Resilience Scale, The Index of Engagement in HIV Care, and the Medical Mistrust Index. We ran a regression-based moderation analysis using the Johnson-Neyman Technique to estimate regions of significance.

RESULTS

The sample ( = 212) was 80.5% Black and 19.5% Latinx with a mean age of 25.8 years ( = 2.84). Higher resilience scores were associated with higher HIV care engagement scores ( = 0.72, = .003), and medical mistrust moderated this relationship as evidenced by a mistrust by resilience interaction ( = -0.16, = .01). Our regions of statistical significance showed that as mistrust increased, the size of the resilience-engagement association decreased.

CONCLUSION

Resilience may be a protective factor associated with greater participation and sense of connection to HIV care, but is diminished by mistrust of the medical system at large. This suggest that systems-level changes, in addition to individual-level interventions, are needed to address medical mistrust to fully harness the resilience of young PLWH. (PsycInfo Database Record (c) 2025 APA, all rights reserved).