title: HIV vaccine acceptability among high-risk drug users in Appalachia: a cross-sectional study.
abstract: 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.
authors.affiliation: Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, Kentucky 40536, USA. april.young@uky.edu.
authors.forename: April M
authors.initials: AM
authors.lastname: Young
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: DiClemente
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Halgin
authors.forename: Claire E
authors.initials: CE
authors.lastname: Sterk
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Havens
mesh_terms: D016915:AIDS Vaccines; D000328:Adult; D000368:Aged; D001061:Appalachian Region; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D055030:Drug Users; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D016915:AIDS Vaccines