By: Ranier Simons, ADAP Blog Guest Contributor
Navigating domestic and global public health is challenging. The difficulty lies in figuring out how to juggle the heterogeneous cultural, social, economic, political, and even physical attributes of groups of people. The ultimate goal is to establish best practices and have populations homogeneously and completely adopt those practices. Unfortunately, such an outcome is virtually impossible.
The world is not new to plagues and pandemics. The plague of Justinian killed 100 million people throughout Egypt and the Roman Empire between 541 and 543 AD. The Black Death, from 1347-1351 AD, killed roughly 200 million people or 30 percent of the European population. Those are just two of many. What they both have in common is the public health response. Just as with Covid-19, evidence showed the efficacy of enhanced sanitation, separation, and isolation.[1]
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| Photo Source: NCBI |
In addition to enhanced sanitation, separation, and isolation, the constantly evolving tool of vaccination is a modern weapon against disease. Global vaccination efforts have eradicated diseases such as smallpox. However, the present state of the Covid-19 vaccination is a daunting conundrum. While there have been aggressive efforts to ensure supply of vaccines is available, availability is not enough. Widespread use and acceptance are key.
Scientific evidence has shown that Covid-19 vaccines are effective. There is also proof that while it’s not a perfect bulletproof panacea, full Covid-19 vaccination results in far better outcomes than being unvaccinated. Regardless, there has been a messaging issue due to many factors including deliberate and inadvertent misinformation, politicization, and lack of consistency.
Several groups at higher risk for seriously adverse outcomes from covid infection have elevated levels of vaccine hesitancy. One of those groups is people who are living with HIV/AIDS. The population of people who are HIV positive is not monolithic. Research shows that older individuals living with HIV for a long time are more likely to have had at least one vaccine dose and have much lower hesitancy among that population.[2] It also shows that African-American and younger people living with HIV were more likely to be unvaccinated.[2]
A study published in AIDS Patient Care and STD’s also showed a disparity in vaccine adoption in HIV-positive individuals based on gender and sexuality.[3] Surveys showed that among the unvaccinated, there was higher intent to get vaccinated among sexual and gender minority individuals (including but not limited to those identifying as LGBT) than non-sexual and gender minority individuals. Additionally, it showed that people with suppressed viral loads were more likely to be vaccinated.
Vaccine hesitation among HIV-positive people is based on many factors. Several major ones are pandemic fatigue, the success of vaccination, pregnancy concerns, and the constantly evolving science around Covid-19 virology and immunology.[3] Pandemic fatigue has resulted in many HIV-positive people mentally distancing themselves from thinking about it. Oddly, the success of getting large numbers of people vaccinated has caused complacency. It has caused some people living with HIV/AIDS to have a much lowered perceived risk of infection. Misinformation about fertility has made some HIV-positive women hesitant due to the belief it will cause sterility. Most importantly, constantly changing and sometimes conflicting information about the science of covid has caused hesitancy due to a lack of public confidence.
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| Photo Source: STAT News |
Effective messaging for HIV-positive people means specific targeting of groups.[4] There needs to be population-sensitive messaging of African-Americans, of younger populations, of cisgendered straight men who don’t receive much messaging or access care as often for their HIV treatment, and women who have fertility and reproductive concerns.
As we advance, it is imperative that vaccine messaging come from trusted sources including antiretroviral therapy staff.[4] Emphasis should be placed on the safety and efficacy of the vaccines. Discussion should be centered on how vaccination can prevent severe disease, hospitalizations, and death. There should be reminders of how the personal choice to get vaccinated helps to protect other unvaccinated family members and fellow neighborhood residents. Most importantly, the motivations behind misinformation should be explained. Misinformation should be countered with responsibly factual and documented information to facilitate the social spread of correct knowledge. These messaging solutions can also translate into changing vaccination messaging for the seronegative vaccine-hesitant population, as well.
[1] Piret, J., & Boivin, G. (2021). Pandemics Throughout History. Frontiers in microbiology, 11, 631736. https://doi.org/10.3389/fmicb.2020.631736
[2] People living with HIV need tailored COVID-19 vaccination information (2022, January 21). Retrieved from https://medicalxpress.com/news/2022-01-people-hiv-tailored-covid-vaccination.html
[3] Ekstrand, Heylen, E., Gandhi, M., Steward, W. T., Pereira, M., & Srinivasan, K. (2021). COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns. Journal of Acquired Immune Deficiency Syndromes (1999), 88(5), 421–425. https://doi.org/10.1097/QAI.0000000000002803
[4] Lila, J. et. al. (2021). Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clinic Proceedings. 96(3). 699-707. https://doi.org/10.1016/j.mayocp.2020.12.024
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.
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