Abstract
Introduction: Scaling up vaccination against COVID-19 is central to controlling the COVID-19 epidemic in the United States. Several vaccines are now approved for the prevention of COVID-19, but public concerns over safety and efficacy have heightened distrust and vaccine hesitancy. This is particularly concerning among people with HIV (PWH) who may be vulnerable to more severe COVID-19 disease. Here, we aimed to identify and understand COVID-19 vaccine hesitancy in a sample of PWH in the U.S. Methods: We conducted a cross-sectional online survey among PWH in the U.S. between 6 December 2020 and 8 January 2021. Measures included demographics, participants’ HIV and health-related attributes, COVID-19 history and experiences, COVID-19 vaccine-related concerns, and standardized measures of attitudes towards COVID-19 vaccines. Multivariate linear regression was used to identify factors associated with vaccine hesitancy in this sample. Results: Among the 1030 respondents, most were male (89.7%), White (66.0%), and identified as gay or lesbian (84.5%). Participants’ mean time living with HIV was 17.0 years (standard deviation (SD) = 11.1). The mean score for vaccine hesitancy was 1.5 (SD = 0.5; range: 1–5); 935 participants (90.8%) had a score greater than 1.0, indicating most participants had some degree of vaccine hesitancy. The final multivariate linear regression showed that greater vaccine hesitancy was associated with being Black (b = 0.149, p = 0.005), single (b = 0.070, p = 0.018), politically conservative (b = 0.157, p = 0.010), “anti-vaxxer” (b = 1.791, p < 0.001), concern about side effects (b = 0.226, p < 0.001), concern about safety (b = 0.260, p < 0.001), and being worried that the vaccine will not be effective (b = 0.169, p = 0.008) and they were being experimented on (b = 0.287, p < 0.001). Participants who were male White (b = −0.093, p = 0.008) and university graduates (b = −0.093, p < 0.001) and had a CD4 count of 200 cells/mm3 (b = −0.082, p = 0.048) and a liberal political orientation (b = −0.131, p < 0.001) were associated with lower vaccine hesitancy. Conclusions: Our findings provide important insights regarding COVID-19 vaccine hesitancy among PWH. Further efforts are required to understand how various social, political, and psychological factors contribute to COVID-19 vaccine hesitancy among key populations.
Highlights
Almost two years after the initial outbreak of SARS-CoV-2, the virus that causesCOVID-19, several variations of the virus that appear to be more infectious continue to pose a grave threat to global public health
Our study contributes to the limited literature on vaccine hesitancy among the nationwide sample of people with HIV (PWH) living in the U.S, revealing most participants having some levels of hesitancy concerning COVID-19 vaccination
Our results indicated that race is associated with vaccine hesitancy, showing that Black PWH were more vaccine-hesitant compared to White PWH
Summary
COVID-19, several variations of the virus that appear to be more infectious continue to pose a grave threat to global public health. Minority groups who choose not to be vaccinated or do not have access to COVID-19 vaccines may complicate those efforts [3]. Substantial barriers to vaccine uptake include one’s ability to access the vaccine (e.g., transportation, cost, and location of services). In addition to these concerns, a significant barrier to uptake, among minority populations, is vaccine hesitancy, which refers to the delay in the acceptance or refusal of vaccines despite availability [4], at least partly attributed to mistrust in the health care system and in the vaccine itself
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