HIV vaccine acceptability among high-risk drug users in Appalachia: A cross-sectional study

April M. Young, Ralph J. Diclemente, Daniel S. Halgin, Claire E. Sterk, Jennifer R. Havens

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. Unfortunately, people who use drugs, particularly those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States. Methods. Interviewer-administered questionnaires included questions about risk behavior and attitudes toward HIV vaccination from 433 HIV-negative drug users (76% with history of injection) enrolled in a cohort study in Central Appalachia. HIV vaccine acceptability was measured on a 4-point Likert scale. Generalized linear mixed models were used to determine correlates to self-report of being "very likely" to receive a 90% effective HIV vaccine (i.e. "maximum vaccine acceptability", or MVA). Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (CIs) are reported. Results: Most (91%) reported that they would accept a preventive HIV vaccine, but concerns about cost, dosing, transportation constraints, vaccine-induced seropositivity, and confidentiality were expressed. Cash incentives, oral-administration, and peer/partner encouragement were anticipated facilitators of uptake. In multivariate analysis, men were significantly less likely to report MVA (AOR: 0.33, CI: 0.21 - 0.52). MVA was more common among participants who believed that they were susceptible to HIV (AOR: 2.31, CI: 1.28 - 4.07), that an HIV vaccine would benefit them (AOR: 2.80, CI: 1.70 - 4.64), and who had positive experiential attitudes toward HIV vaccination (AOR: 1.85, CI: 1.08 - 3.17). MVA was also more common among participants who believed that others would encourage them to get vaccinated and anticipated that their behavior would be influenced by others' encouragement (AOR: 1.81, 95% 1.09 - 3.01). Conclusions: To our knowledge, this study was among the first to explore and provide evidence for feasibility of HIV vaccination in a rural, high-risk population in the United States. This study provides preliminary evidence that gender-specific targeting in vaccine promotion may be necessary to promoting vaccine uptake in this setting, particularly among men. The data also underscore the importance of addressing perceived risks and benefits, social norms, and logistical constraints in efforts to achieve widespread vaccine coverage in this high-risk population.

Original languageEnglish
Article number537
JournalBMC Public Health
Issue number1
StatePublished - May 30 2014

Bibliographical note

Funding Information:
The Social Networks among Appalachian People (SNAP) Study is funded by the National Institute on Drug Abuse (R01DA024598 and R01DA033862 to J.R.H). Data collection on attitudes surrounding HIV vaccination was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR000117 to J.R.H). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The sponsors had no role in the study design, collection, analysis and interpretation of data, report preparation, or in the decision to submit the article for publication. The authors would like to acknowledge Dr. Hannah Cooper for her input during the conceptualization of the study and her thoughtful review of manuscript drafts. The authors would also like to thank the reviewers for their thoughtful review of the manuscript and suggestions for its improvement.


  • AIDS vaccines
  • Attitude
  • Drug users
  • HIV
  • HIV vaccines
  • Psychological theory
  • Rural health
  • Vaccination

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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