Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Despite behavioral prevention efforts, albeit hindered by insufficient funding and political obstacles, the estimated annual number of HIV incident infections in the U.S. has remained constant at 40,000 since 1990. The development of safe and efficacious HIV vaccines represents the greatest hope for controlling the AIDS pandemic; 30 vaccine trials are now in progress. Nevertheless, HIV vaccine availability will not ensure appropriate dissemination, particularly among vulnerable communities at greatest risk for HIV/AIDS. This study explored and assessed beliefs and concerns about future HIV vaccines among low socioeconomic, ethnically diverse adults at elevated risk for HIV/AIDS.

Methods: A mixed-method investigation included 15 focus groups with adults (n=157; median age=34; 44% women; 27% African American, 48% Latino, 20% white; 52% with annual income <$10,000) recruited from needle exchange programs, gay community centers and Latino public healthcare clinics in Los Angeles. Key informant interviews were conducted with 9 service providers, community advocates and HIV vaccine experts. Focus groups and key informant interviews were audiotaped, transcribed verbatim and data were analyzed using narrative thematic analysis and a constant comparative method, with Ethnograph qualitative software. Member checking and triangulation of data collection methods, data sources and researchers were used to enhance the trustworthiness of the findings. A cross-sectional survey was designed by identifying domains elicited from focus groups and interviews, and then utilizing both established and newly developed questions to assess these domains (e.g., beliefs about HIV/AIDS and HIV vaccines, trust in government, and healthcare experiences). The survey was administered on laptop computers to 266 adults (median age=38; 36% women; 18% African American, 34% Latino, 36% white; 42% with annual income <$10,000) recruited using multi-site (n=9), venue-based sampling among vulnerable communities in Los Angeles.

Results: Qualitative findings revealed fear of contracting HIV from a vaccine, mistrust of government, pharmaceutical companies and the healthcare system, AIDS conspiracy theories, and concerns about stigma and discrimination in seeking out and getting an HIV vaccine. Survey data revealed almost half (45%) were concerned they might contract HIV from a vaccine. AIDS conspiracy beliefs were pervasive: 50% believed the government and pharmaceutical companies, respectively, had an HIV vaccine but were suppressing it; over one-third believed the U.S. government was using HIV/AIDS as a form of genocide. Half reported concerns about confidentiality if they received an HIV vaccine and 40% feared the vaccine would cause difficulties in getting health insurance. One-fifth reported having been refused service by medical providers; 30% feared getting an HIV vaccine would lead to discrimination against them.

Implications for Practice and Policy: Widespread HIV vaccine concerns, misconceptions and mistrust among vulnerable communities present formidable challenges to HIV vaccine dissemination, and may compromise the effectiveness of future vaccines in controlling the AIDS pandemic. Possible vaccine candidates currently in testing cannot cause HIV infection; yet perceptions and mistrust may influence behavior. Culturally appropriate, empirically-based educational and social marketing interventions and community engagement may be vital to address vaccine concerns and mistrust, in order to facilitate successful HIV vaccine dissemination among communities at elevated risk for HIV/AIDS.