Health Brief

Juanita M. Firestone, Ph.D.
MRPI Faculty Associate

Issue

There is a negative stigma attached to individuals with HIV disease and AIDS in San Antonio, and their access to important information and services may be impeded compared to the larger gay community in San Antonio. The stigma attached to their illness conflicts with their dependence on government health and supportive services, and the great difficulty in finding and funding adequate treatments. As a result individuals with HIV disease, or with AIDS, may have less confidence in San Antonio institutions designed to support their needs. It is also likely, given the stigma attached to their disease, that they would have less trust in people in general. Both trust of individuals and confidence in institutions are important to improve effective and efficient provision of services by community agencies, thereby potentially increasing survival rates and lowering treatment costs.

Data and Methods

The sampling strategy was designed in two main parts: 1) Each community agency was asked to provide a “convenience” sample of at least five on-site clients, paying attention to representing the diversity of their clients in terms of age, gender, race and ethnicity, and stage of illness. Agency representatives attended a training session on November 29, 1995, focusing on procedures for obtaining consent forms and conducting the on-site interviews. This non-random convenience subset can be expected to represent the population of on-site users of services from December of 1995 through June of 1996. 2) A file of unique identifiers provided by the various service providers, based on data from January 1, 1995 through December 15, 1996, was compiled as the source of a stratified random sample of all known HIV positive and AIDS patients. This randomly drawn sample was designed to represent all known HIV positive and AIDS cases whether or not they are current on-site users of services. The desired completed sample size was set at 285 completed surveys, to produce a plus or minus 5% probability of error based on the estimated size of the client population.

We compared responses from this sample to responses from the 1994 General Social Survey (GSS) on questions related to institutional confidence and levels of trust in people. The GSS provides responses to a variety of issues related to public attitudes and concerns from a stratified random probability sample of individuals 18 years or older, who are English-speaking and non-institutionalized. Eight questions, five related to trust in institutions, and three to trust in people from the 1994 GSS were also asked of all respondents to the San Antonio Needs Assessment and Client Survey.

Discussion

Individuals with HIV disease or AIDS are only somewhat more likely than the general public to lack confidence in major government, scientific or medical institutions. This does not seem unusual given the stigma of HIV infection and the dependence on government sponsored services to manage the biological and social aspects of HIV infection, and prolong the life of infected individuals with affordable and efficacious treatment.

The proportions of those expressing a “great deal” of confidence in medicine was about the same for each group, and slightly higher for HIV group (43.2% compared to 41.3%). However, 38.3% of the clients compared to 47.8% of the national group said they had “only some” confidence in medicine. And 13.2% of those with HIV disease or AIDS compared 9.7% of the GSS respondents said they had “hardly any” confidence in medicine. Confidence in the scientific community and Congress are distinctly lower among this group than the national sample. Only 27.9% of clients said they have a “great deal” of trust in the scientific community, compared to 38.2% of the respondents to the GSS, and only 37.9% of this group compared to 49% of national group said they had “only some” trust. Most telling perhaps, 21.2% of the San Antonio respondents compared to 7% of the national respondents said they had “hardly any” trust in the scientific community. This lack of confidence could negatively impact clients’ willingness to seek out institutional support. Because HIV disease must be managed carefully, this process would then have a negative impact on effective prevention and control over the spread of AIDS.

Interestingly, these respondents are more likely than the general public to say they trust other people, although they are also more likely to respond with a qualified trust (i.e. “it depends”). Respondents to the HIV client survey were almost equally likely (32.1%) as the national sample (33.9%) to say that “most people can be trusted,” and less likely to say that “you can’t be too careful” in dealing with people (41.2%, compared to 61.1%). This level of trust may emanate from the fact that the service providers in the San Antonio community have worked at meeting the needs of those clients using their services. Because they are dependent on those agencies for their daily lives, they deal with the service providers on a regular basis. If their experience is positive, they should develop a sense of trust in the agencies and the individuals who work within them. It seems likely that the same trust they have developed in agency personnel would carry over into their views of the general public.

Recommendations

The complimentary issues of confidence in institutions and trust in individuals are important for insuring that San Antonio’s community agencies are more effectively managing the needs of individuals with HIV disease and AIDS. The primary issue is one of communication.

Members of an isolated group must trust gatekeepers of HIV services, or providers of services, before they can confidently communicate their needs and accept suggestions for managing their illness or lowering their risk of infecting others.