Abstract
BACKGROUND: Despite efficacy of COVID-19 vaccines in preventing severe complications of infection, there remains vaccine hesitancy. We examined COVID-19 vaccine uptake and vaccine hesitancy among persons living with HIV (PWH). METHODS: A nested survey was administered to women in the District of Columbia MACS-WIHS Combined Cohort Study (October 01, 2020-September 30, 2022). The survey included questions on vaccine receipt, medical mistrust, government trust, and vaccine attitudes. Sociodemographic and medical comorbidity data were collected at routine study visits. RESULTS: Among 254 women, 75% (n = 190) were African American/Black, and 70% (n = 178) were PWH, and 82% (n = 208) received a complete COVID-19 vaccine series. Vaccine completion rate was similar among PWH and women without HIV. The top reasons for a participant's vaccine decision were personal choice 46% (n = 113), health care provider recommendation 24% (n = 60), and family influence 31% (n = 13). Sixty-five percent (n = 159) endorsed concern about unknown vaccine side effects. The mean medical mistrust score was 32.4 (SD 3.8, range 12-60, higher scores indicate more mistrust). In adjusted analysis, older age [aOR = 1.05 (95% CI: 1 to 1.1, P = 0.032)], prior testing for COVID-19 [aOR = 3.50 (95% CI: 1.23 to 9.99, P = 0.019)], and feeling protected after being vaccinated [aOR = 4.65 (95% CI: 1.98 to 10.91, P < 0.001)] were associated with receipt of COVID-19 vaccines. There was no association between medical mistrust [aOR = 1.01 (95% CI: 0.95 to 1.06, P = 0.87)] or concerns about vaccine safety [aOR = 0.57 (95% CI: 0.26 to 1.28, P = 0.17)] and receipt of COVID-19 vaccines. CONCLUSIONS: Concern about potential risks associated with vaccines remains a significant challenge. Interventions emphasizing protective benefits of vaccines using shared decision making may be useful for public health campaigns.