The first generation of FDA-approved HIV vaccines may be available to the public within the next 10 years. Researchers, supported in part by the Agency for Healthcare Research and Quality (T32 HS00046), held focus groups with mostly poor and unemployed women at risk for HIV infection in Los Angeles to investigate barriers to acceptance of a future HIV vaccine.
Barriers included fear of vaccine-induced HIV infection and reproductive side effects (ranging from effects on the fetus to infection of breast milk). Another barrier involved gender roles and power dynamics. Women, especially black and Latina women, cited ethnic norms that interfered with their ability to discuss sex and getting an HIV vaccine with their male partners. For example, they cited fear of a husband's mistrust and negative reactions that would make it difficult for women to communicate a desire to get vaccinated. Also, men were often in denial of their own HIV risk behaviors (some of which were culturally sanctioned) and, if a woman got the vaccine, it would reflect negatively on their "machismo."
Other barriers to vaccination included HIV stigma (particularly among Latina and black women that they were gay or sexually promiscuous), concerns about discrimination (who is considered "at-risk" and who "deserves" a vaccine), vaccine affordability, and mistrust of the government. Vaccine facilitators included empowerment to protect oneself against HIV infection and integration of HIV vaccines into routine health care.
See "HIV vaccine acceptability among women at risk: Perceived barriers and facilitators to future HIV vaccine uptake," by Ellen T. Rudy Ph.D., Peter A. Newman, Ph.D., Naihua Duan, Ph.D., and others, in the June 2005 AIDS Education and Prevention 17(3), pp. 253-267.
Editor's note: Another HIV study found that HIV-infected persons with mental health problems were far more likely to use general medical services than HIV-infected persons without such problems. For more details, see Joyce, G.F., Chan, K.S., Orlando, M., and Burnam, M.A. (2005, August). "Mental health status and use of general medical services for persons with human immunodeficiency virus." (AHRQ grant HS08578). Medical Care 43(8), pp. 834-839.