Abstract
BackgroundA vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. Unfortunately, people who use drugs, particularly those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States.MethodsInterviewer-administered questionnaires included questions about risk behavior and attitudes toward HIV vaccination from 433 HIV-negative drug users (76% with history of injection) enrolled in a cohort study in Central Appalachia. HIV vaccine acceptability was measured on a 4-point Likert scale. Generalized linear mixed models were used to determine correlates to self-report of being “very likely” to receive a 90% effective HIV vaccine (i.e. “maximum vaccine acceptability”, or MVA). Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (CIs) are reported.ResultsMost (91%) reported that they would accept a preventive HIV vaccine, but concerns about cost, dosing, transportation constraints, vaccine-induced seropositivity, and confidentiality were expressed. Cash incentives, oral-administration, and peer/partner encouragement were anticipated facilitators of uptake. In multivariate analysis, men were significantly less likely to report MVA (AOR: 0.33, CI: 0.21 – 0.52). MVA was more common among participants who believed that they were susceptible to HIV (AOR: 2.31, CI: 1.28 – 4.07), that an HIV vaccine would benefit them (AOR: 2.80, CI: 1.70 – 4.64), and who had positive experiential attitudes toward HIV vaccination (AOR: 1.85, CI: 1.08 – 3.17). MVA was also more common among participants who believed that others would encourage them to get vaccinated and anticipated that their behavior would be influenced by others' encouragement (AOR: 1.81, 95% 1.09 – 3.01).ConclusionsTo our knowledge, this study was among the first to explore and provide evidence for feasibility of HIV vaccination in a rural, high-risk population in the United States. This study provides preliminary evidence that gender-specific targeting in vaccine promotion may be necessary to promoting vaccine uptake in this setting, particularly among men. The data also underscore the importance of addressing perceived risks and benefits, social norms, and logistical constraints in efforts to achieve widespread vaccine coverage in this high-risk population.
Highlights
A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern
In response to the possibility that an HIV vaccine is on the horizon, researchers have mobilized to examine the feasibility of disseminating the vaccine
The purpose of this study was to examine demographic, behavioral, and psychosocial correlates to HIV vaccine acceptability among a sample of HIV negative, high-risk drug users in Central Appalachia
Summary
A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. People who use drugs, those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States. Qualitative studies on HIV vaccine acceptability are limited, as most of those involving people who use drugs have been conducted in one setting (i.e. Los Angeles) [6,7,8,9,10,11]. There are no studies to date evaluating HIV vaccine acceptability in a high-risk, rural drug-using population in the US. National surveillance data indicate that while the prevalence of AIDS has gradually declined in most urban areas since the mid 1980's, the number of cases continues to slowly increase in many rural communities, in the South [12,13]. Given the historically low prevalence of HIV in rural areas and the common misconception that HIV is an “urban problem”, many rural communities are unequipped to deal with the social, economic, and healthcare burden posed by an increase in HIV
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