People Living With HIV Are a Model Population for Vaccination

TAMPA, Florida — People living with HIV (PLWH) were more likely than other populations to get vaccinated for flu and COVID-19, to seek reputable sources of information, and to be connected through essential community organizations that share essential health and wellness information, according to the results of a large survey.

PLWH, therefore, would have been an ideal model population for creating and disseminating effective messaging around COVID-19 immunizations earlier in the pandemic, said Kathleen Gallagher, MPH, an epidemiologist, researcher, and health services administrator at the Patient Advocate Foundation.

The PLWH community can still offer valuable insights into effective ways to reach out to people, to disseminate correct information, and to link people with resources, Gallagher told Medscape Medical News during a poster presentation here at the Association of Nurses in AIDS Care (ANAC) 2022 Annual Meeting.

In addition, the PLWH response to the pandemic illustrates the importance of community. Local, community-based organizations “are the people that these individuals trust, they are people entrenched in their community, and they have existing relationships with them in terms of getting vaccinated and listening to their concerns,” Gallagher said.

“It’s a missed opportunity.”

A Highly Compliant Group

The July 2021 survey of 271 PLWH was part of a larger, longitudinal survey of 1400 people with any chronic illness asked about attitudes and barriers to vaccination. The PLWH population was important to focus on, the researchers note, because they could be potentially high risk for more serious COVID-19 outcomes.

The PLWH group was 81% White and 90% male, and 83% were age 56 or older. In addition, 86% had an annual household income below $48,000.

Ninety-three percent of the PLWH group had had flu vaccination in the prior 3 years and received at least one COVID-19 vaccination.

Unable vs Unwilling to Vaccinate

Gallagher and colleagues found 12 people (4%) in the PLWH group did not get vaccinated against COVID-19. It’s a small number “so you have to take this with a grain of salt,” she said. “But we asked them why they were hesitant. They either were unable or unwilling — and the unable part is not surprising.”

Those who were unable to get vaccinated were either homebound or had concerns about being in a clinic where they could be exposed to COVID while waiting to get the vaccine.

“And then there were some who were just not willing” to get vaccinated, Gallagher said. She added most cited vaccine safety concerns and “a lot of the misinformation or confusing information around efficacy.”

Trusted Information Sources

Although people reported getting COVID-19 vaccine information from multiple sources, including online and from television, 64% or nearly two thirds sought information from their doctors or healthcare teams.

In fact, doctors emerged as the most trusted source, as indicated by 72% of PLWH.

“I was a little surprised that doctors scored so highly because, sometimes in other cohorts that we looked at, it wasn’t the case,” Gallagher said. However, she added, a lot of PLWH “have a very strong trust bond with their provider because this is a very personal, very sensitive diagnosis.”

How did social media score? “A whopping 1%,” she said. “So at least this was a savvy group, and they realized that that was not the place to go for vaccination information.”

Overcoming Barriers

A lack of vaccine availability at the time of their appointment was the number one barrier to immunization. Also, a small number of people said knowing someone who had an adverse reaction to COVID-19 vaccination was a barrier for them. Gallagher explained that, by definition in the survey, an adverse reaction to vaccination had to be serious enough to drive people to seek medical care.

When asked to comment on the poster, Andrew Komensky, RN, told Medscape Medical News he found the results “interesting because I’m an infection preventionist, in addition to being an HIV nurse.” He is director of infection prevention and control at CharterCARE Health Partners in Providence, Rhode Island.

Komensky said he was surprised that a high proportion of PLWH cited their doctor — and not their nurse — as the most trusted source of information. “In my experience in COVID care…it was a nursing staff who had most of the contact with patients, who did most of the education and provided most of the information surrounding vaccination and potential side effects.”

It made sense to Komensky that the PLWH population would be compliant with vaccinations. “People who are living with HIV do everything they possibly can just to stay healthy.”

ANAC 2022 Annual Meeting. Abstract P-31. November 17, 2022.

The study was independently supported. Gallagher and Komensky have reported no relevant financial relationships. 

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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