National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-A0102
Newman PA, Duan N, Rudy E, Swendeman D, Roberts KJ
University of Toronto, Toronto, ON, Canada

BACKGROUND/OBJECTIVES:: HIV vaccines may offer the best hope of controlling the AIDS pandemic. Yet, availability does not ensure adoption. Suboptimal adoption of existing vaccines, marked health care disparities, HIV/AIDS stigma and mistrust of the medical establishment suggest formidable challenges to HIV vaccine dissemination. Possible risk behavior increases in response to availability of FDA-approved HIV vaccines, as suggested by risk behavior increases subsequent to HAART and among some HIV vaccine trial participants, could offset the benefits of partially efficacious vaccines. The purpose of this study is to assess consumer concerns, motivators, and adoption and risk behavior intentions in response to hypothetical FDA-approved HIV vaccines, as a first step to prepare for the forthcoming challenges for HIV vaccine dissemination.

METHODS: Phase 1. Nine 90-minute client focus groups (3 in Spanish; N = 99; 46% female; 43% Latino, 22% African American, 30% white) and nine 60-minute provider key informant interviews were conducted. Participants were recruited using purposive, venue-based sampling among STD clinics and community centers serving gay/ bisexual men, needle exchange programs, and Latino and African American community agencies in Los Angeles. A semi-structured interview guide using scripted probes elicited knowledge, concerns, motivators, adoption and risk behavior intentions regarding hypothetical FDA-approved HIV vaccines. Data were transcribed verbatim, coded and analyzed using narrative thematic analysis with Ethnograph qualitative analysis software. Phase 2. A survey questionnaire has been constructed and programmed onto laptop computers, including domains evidenced in focus group results and a series of hypothetical HIV vaccine scenarios that systematically vary key vaccine characteristics (e.g., 50% vs. 90% efficacy; single vs. cross-clade protection). The survey is being implemented with 200 participants recruited from high-risk venues in Los Angeles. As part of an iterative, consumer-focused research process, survey results will be analyzed and revisited in focus group settings among audiences segmented by differential concerns and risks in regard to HIV vaccines, in order to design and test tailored interventions to increase vaccine adoption and avert risk behavior increases.

RESULTS: Adoption concerns included suboptimal efficacy, vaccine-induced infection, side effects, testing HIV-positive, distrust of government/medical research, cost/access and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partially efficacious vaccines and a high likelihood of increased sexual, and to a lesser extent injection risk behaviors in response to vaccine deployment.

CONCLUSIONS: Post-trial HIV vaccine adoption and potential risk behavior increases represent key challenges to the success of future HIV vaccines in controlling the AIDS pandemic. A consumer research agenda based on social marketing principles may enable us to: 1) design tailored educational materials and interventions to facilitate post-trial HIV vaccine adoption and follow-through; 2) identify vaccine characteristics most likely to increase uptake and assess consumer flexibility in the face of various HIV vaccine parameters; 3) inform the design of preventive interventions to be launched in tandem with HIV vaccine deployment to avert increases in HIV risk behaviors; and 4) inform mathematical modeling of the effects of HIV immunization on the epidemiology of HIV/AIDS.

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M1-A0102

Copyright notice: The National HIV Prevention Conference is collaborative effort by the Centers for Disease Control and Prevention, a U.S. Government agency and other governmental and non-government organizations. All abstracts published in by the conference organizers are in the public domain and can be used without permission. Proper citation, however, is required.