“I’m Afraid to Put Any More of It Into My Body”: COVID-19 Vaccination and Booster Barriers and Facilitators Among People with HIV in South Carolina

TL;DR

This study explores why people with HIV in South Carolina get or avoid COVID-19 vaccines and boosters, highlighting personal, social, and structural factors.

Contribution

The study provides a nuanced understanding of vaccination barriers and facilitators specific to people with HIV using a socioecological model.

Findings

Positive personal vaccination history and the desire to protect others facilitated vaccine uptake.

Misinformation and skepticism about vaccine development acted as significant barriers.

Healthcare providers and family influenced vaccination decisions both positively and negatively.

Abstract

As people with HIV (PWH) have an immunocompromised status and face potential complications from a COVID-19 infection, there are alternate, more expansive, vaccination schedules recommended for PWH. As the pandemic evolves and prevention fatigue rises, the vaccination sentiments and hesitancy of PWH require attention amid continued recommendations for boosters. Situated within South Carolina, this study aims to illustrate PWH’s vaccination sentiments, as well as barriers and facilitators to vaccination. Semi-structured interviews were conducted online between March and August of 2023, among 24 PWH who were snowball and purposively sampled at a local AIDS Service Organization. An abductive approach was employed. All interviews were recorded, transcribed, and coded using an inductive, thematic analysis approach to identify and analyze emergent themes, which were then deductively categorized into the socioecological model. At the individual level, the need to protect oneself and others, prioritization of vaccination due to HIV status, and a positive personal history of vaccination facilitated uptake while a negative personal history acted as a barrier. Within the interpersonal and institutional level, family and friends as well as healthcare providers were found to serve as both positive and negative vaccine messengers. At the structural level, vaccine requirements and mandates (e.g., employer, travel) facilitated uptake while misinformation, misunderstanding, and skepticism (e.g., pace and process of vaccine development) acted as barriers to uptake. Tailored vaccination education and enhanced trust between providers and PWH may improve vaccination sentiments and mitigate hesitancy, as additional doses continue to be recommended.