People living with HIV need better COVID vaccination information

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Rutgers University research is highlighting health needs

While most people living with HIV have received at least one dose of the COVID-19 vaccine, younger and Black individuals are hesitant to get vaccinated and have lower vaccination rates, according to a new study by Rutgers researchers.

The study, published in AIDS Patient Care and STDs, is among the first to examine COVID-19 vaccination efforts based on people living with HIV in the United States.

The researchers nationally surveyed people living with HIV between March and May of 2021 —at the onset of the vaccination program — and found that while most individuals had reported receiving at least one dose of a vaccine, certain subgroups had fewer or less intentions of getting vaccinated.

“Examining aspects of medical mistrust is much more than just being like, ‘Oh, I don’t trust my doctor.’ It’s actually systemic mistrust in the system, which has historically disenfranchised many, many different communities at large,” said Dr. Kristen D. Krause, instructor at the Rutgers School of Public Health and deputy director of the Center for Health, Identity, Behavior & Prevention Studies, which collected the data. “Its history is definitely rooted within racial and ethnic minority folks, but there’s something to also be said about LGBT folks and the community as a whole.”

Participants who were older and had been living with HIV for a longer period of time were more likely to have received at least one dose of the vaccine, showed less vaccine hesitancy, and had higher perceived vulnerability to COVID-19. Rates of vaccination were also highest among sexual and gender minority cisgender men and transgender participants, as well as those more likely to report an undetectable viral load.

Among the unvaccinated people living with HIV who completed the survey, sexual and gender minority individuals — who include but are not limited to individuals who identify as lesbian, gay, bisexual, asexual, and transgender — demonstrated higher intent to get vaccinated than non-sexual and gender minority individuals.

“Historically, people living with HIV, but also sexual and gender minority folks, are used to getting public health messaging thrown at them from various resources like, ‘make sure you wear a condom,’ ‘make sure that you’re having safe sex, etc.,’” said Dr. Krause. “Historically speaking, especially in the context of HIV, this is a group that’s just a little bit more used to hearing messages around public health.”

She continued, “So, when it came time to being socially distant, or wearing a mask, or getting the vaccine, this is a group that may be more likely to do that, just because historically, it’s something that they’re more used to.

The researchers also found that Black participants were least likely to be vaccinated, which is consistent with other studies that have demonstrated the relation between race and residential segregation for individuals infected with HIV and COVID-19 in the United States, where people of color tend to live in less economically advantaged neighborhoods.

According to Perry N. Halkitis, dean of the Rutgers School of Public Health and Director of the Center for Health, Identity, Behavior & Prevention Studies, this study highlighted the importance of providing access to trusted healthcare for minority groups.

He said, “Our findings suggest that successfully managing COVID-19 and HIV is predicated largely on continued access to trusted health care providers and trusted sources of health information, which likely affects decision-making around vaccine uptake as well as treatments for both HIV and COVID-19.”

While COVID-19 vaccination rates have likely increased since the survey was conducted, the researchers said that their results are important when considering the possibility of an annual COVID-19 vaccine.

“Increasing and maintaining access to vaccination for people living with HIV is crucial especially as we expect COVID-19 to become endemic, requiring an annual dose or booster,” added Halkitis.

The researchers call for tailored public health messaging around the importance of vaccination for people living with HIV, particularly those who are younger, Black, Latinx or do not have regular exposure to health messaging, like cisgender straight men who are less likely to access care for HIV, and cisgender women who have regularly expressed false concerns about the potential effects of the vaccine on fertility and reproductive health.

For people living with HIV of various socio-demographic backgrounds, it is essential that communication of health information provides a genuine understanding of various communities’ concerns and acts in partnership to address the hesitations.

“The findings from this study also underscore the significance of having a multidimensional approach to promoting the importance of COVID-19 vaccines,” said Dr. Krause. “It has become clear over time that a one-size-fits-all approach will not work for everyone, and those living with HIV/AIDS are no different, even if they are used to public health messaging.”

This work shows that no group should be treated as monolithic as is too often the approach of medical providers. Health care providers, as well as public health messaging, must attend to the many intersectional identities people hold, researchers say.