Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA.

Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.