HIV vaccine acceptability among high-risk drug users living in a low-prevalence community

Background: An HIV vaccine could substantially impact the epidemic, but adequate uptake is a concern, particularly in populations with low perceived HIV risk. This study examined HIV vaccine acceptability among high-risk drug users in a rural setting. Methods: Interviewer-administered questionnaires collected data on risk behavior and attitudes toward HIV vaccination from 347 HIV-negative drug users (70% with history of injection) enrolled in a cohort study in Appalachia. Results: Only 24% believed that they were at risk for HIV, yet 92% reported that they would accept a HIV vaccine that was 90% effective. Only 25% would accept a vaccine that was less than 90% effective. The median price respondents were willing to pay out-of-pocket for a 90% effective vaccine was $100. The most commonly cited barrier to vaccine acceptability was cost (79%), followed by requirement for multiple doses (32%), transportation and time to visit the clinic (22% and 12%, respectively), and fear that the provider would tell others about the patient's vaccination (15%). Also, 47% reported that they would be less likely to get a vaccine that caused future HIV tests to be positive. Factors that could increase uptake include oral administration (44%) and monetary incentives (64%). Many believed they would remain at risk for HIV from unprotected sex (29%) or equipment-sharing (41%) if they received a 90% effective vaccine. Conclusions: Despite low perceived risk, vaccine acceptability was nearly ubiquitous. However, characteristics such as cost, administration, and dosing could substantially impact uptake, as well as providers' accessibility and respect of confidentiality.