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 (<em>N</em> = 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 (<em>N</em> = 212) was 80.5% Black and 19.5% Latinx with a mean age of 25.8 years (<em>SD</em> = 2.84). Higher resilience scores were associated with higher HIV care engagement scores (<em>b</em> = 0.72, <em>p</em> = .003), and medical mistrust moderated this relationship as evidenced by a mistrust by resilience interaction (<em>b</em> = -0.16, <em>p</em> = .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.