Abstract
Objectives
Black women in Canada are at disproportionately high risk for HIV. We assessed HIV vaccine acceptability and correlates of acceptability among Black women from African and Caribbean communities in Toronto.
Methods
“Sisters, Daughters, Mothers, and Aunties” was a community-based research project. Black women of African and Caribbean descent were recruited using venue-based sampling across diverse community organizations in Toronto. We used a structured questionnaire to collect data on socio-demographic characteristics and acceptability of 8 future HIV vaccines, each defined by a set of 7 dichotomous attributes. Conjoint analysis was used to quantify the relative impact of vaccine attributes on acceptability, with multiple regression to adjust for socio-demographic characteristics associated with overall acceptability.
Results
Mean vaccine acceptability was 58.8 (SD=17.2) on the 100-point scale. Efficacy had the greatest impact on acceptability, followed by side effects, cost, duration of protection, and number of doses. Acceptability of a high (99%) efficacy vaccine (70.1/100) was significantly greater than for a 50% efficacy vaccine (47.6/100). Vaccine acceptability was significantly higher among women of Caribbean versus African descent, ever married versus single women, and women with full-time versus part-time employment.
Conclusions
Black women in Toronto indicated a modest level of acceptability for future HIV vaccines. Educational interventions that address the benefits of partially efficacious vaccines and clearly explain potential side effects, as well as vaccine cost subsidies may promote HIV vaccine uptake. Differences in acceptability within Black communities suggest that tailored multi-level interventions may mitigate barriers to uptake.
Key Words: AIDS vaccines, acceptability of healthcare, conjoint analysis, African, Caribbean and other Black women, Canada
Résumé
Objectifs
Le risque de contracter le VIH est démesurément plus élevé chez les femmes noires au Canada. Nous avons évalué l’acceptabilité des vaccins anti-VIH et les corrélats de cette acceptabilité chez les femmes noires des communautés africaines et caribéennes de Toronto.
Méthode
«Sisters, Daughters, Mothers, and Aunties» est le nom d’un projet de recherche communautaire. Des femmes noires d’ascendance africaine et caribéenne ont été recrutées par échantillonnage dans les lieux de rencontre de divers organismes communautaires de Toronto. Nous avons utilisé un questionnaire structuré pour recueillir des données sur les caractéristiques sociodémographiques et l’acceptabilité de huit futurs vaccins anti-VIH, chacun étant défini par un ensemble de sept attributs dichotomiques. Une analyse conjointe a servi à chiffrer l’impact relatif des attributs des vaccins sur leur acceptabilité, et nous avons fait appel à la régression multiple pour tenir compte des caractéristiques sociodémographiques associées à leur acceptabilité globale.
Résultats
L’acceptabilité moyenne des vaccins était de 58,8 (écart-type de 17,2) sur une échelle de 100 points. L’efficacité potentielle du vaccin avait le plus grand impact sur son acceptabilité, suivie par ses effets secondaires, son coût, sa durée de la protection et son nombre de doses. L’acceptabilité d’un vaccin à haute (99 %) efficacité potentielle était significativement plus élevée (70,1/100) que celle d’un vaccin à l’efficacité potentielle de 50 % (47,6/100). L’acceptabilité des vaccins était significativement plus élevée chez les femmes d’origine caribéenne que chez celles d’origine africaine, chez les femmes ayant été mariées que chez les célibataires, et chez les femmes ayant un emploi à plein temps plutôt qu’un emploi à temps partiel.
Conclusions
Le niveau d’acceptation des futurs vaccins anti-VIH par les femmes noires de Toronto est modeste. Des interventions éducatives qui portent sur les avantages des vaccins partiellement efficaces et qui expliquent clairement leurs effets secondaires potentiels, ainsi que des subventions au coût des vaccins, pourraient favoriser le recours aux vaccins anti-VIH. Les écarts dans les niveaux d’acceptabilité au sein de la communauté noire montrent que des interventions multiniveaux adaptées pourraient atténuer les obstacles à l’acceptation de ces vaccins.
Mots Clés: vaccins contre le SIDA, acceptation des soins, analyse conjointe, femmes africaines, caribéennes et autres femmes noires, Canada
Footnotes
Source of support: Canadian Institutes of Health Research; Canada Research Chairs programme.
Conflict of Interest: None to declare.
References
- 1.Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, Kaewkungwal J, Chiu J, Paris R, et al. Vaccination with ALVAC and AINDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009;361:2209–20. doi: 10.1056/NEJMoa0908492. [DOI] [PubMed] [Google Scholar]
- 2.Joint United Nations Programme on HIV/AIDS UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic 2012. Geneva, Switzerland: UNAIDS; 2012. [Google Scholar]
- 3.Bonner S. Implementation science and urban health research. J Urban Health. 2009;86(2):157–60. doi: 10.1007/s11524-008-9327-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Newman PA, Duan N, Rudy ET, Anton PA. Challenges for HIV vaccine dissemination and clinical trial recruitment: If we build it, will they come? AIDS Patient Care STDS. 2004;18(12):691–701. doi: 10.1089/apc.2004.18.691. [DOI] [PubMed] [Google Scholar]
- 5.Newman PA, Lee SJ, Duan N, Rudy E, Nakazono TK, Boscardin J, et al. Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (L.A. VOICES) Health Serv Res. 2009;44(6):2167–79. doi: 10.1111/j.1475-6773.2009.01039.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Newman PA, Logie C. HIV vaccine acceptability: A systematic review and meta-analysis. AIDS. 2010;24(11):1749–56. doi: 10.1097/QAD.0b013e32833adbe8. [DOI] [PubMed] [Google Scholar]
- 7.Remis RS, Swantee C, Liu J. HIV/AIDS in Ontario: Preliminary Report, 2010. 2013. [Google Scholar]
- 8.Statistics Canada. Visible Minority Groups, Percentage Distribution, for Canada, Provinces and Territories — 20% sample data. 2013. [Google Scholar]
- 9.Liu J, Remis RS. Race/Ethnicity Among Persons with HIV/AIDS in Ontario, 1981–2004. 2013. [Google Scholar]
- 10.Centers for Disease ControlPrevention CDC. HIV Among Women. 2013. [Google Scholar]
- 11.Centers for Disease ControlPrevention CDC. HIV among African Americans. 2013. [Google Scholar]
- 12.Newman PA, Williams CC, Massaquoi N, Brown M, Logie C. HIV prevention for black women: Structural barriers and opportunities. J Health Care Poor Underserved. 2008;19(3):829–41. doi: 10.1353/hpu.0.0043. [DOI] [PubMed] [Google Scholar]
- 13.Williams CC, Newman PA, Sakamoto I, Massaquoi NA. HIV prevention risks for black women in Canada. Soc Sci Med. 2009;68(1):12–20. doi: 10.1016/j.socscimed.2008.09.043. [DOI] [PubMed] [Google Scholar]
- 14.Hay JW. Conjoint analysis in pharmaceutical research. J Manag Care Pharm. 2002;8:206–8. [Google Scholar]
- 15.Lee SJ, Newman PA, Comulada WS, Cunningham WE, Duan N. Use of conjoint analysis to assess HIV vaccine acceptability: Feasibility of an innovation in the assessment of consumer health-care preference. Int J STD AIDS. 2012;23(4):235–41. doi: 10.1258/ijsa.2011.011189. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Crosby RA, Holtgrave DR, Bryant LB, Frew PM. Factors associated with the acceptance of an AIDS vaccine: An exploratory study. Prev Med. 2004;39:804–8. doi: 10.1016/j.ypmed.2004.03.004. [DOI] [PubMed] [Google Scholar]
- 17.Rudy ET, Newman PA, Duan N, Kelly EM, Roberts KJ, Seiden DS. HIV vaccine acceptability among women at risk: Perceived barriers and facilitators to future HIV vaccine uptake. AIDS Educ Prev. 2005;17(3):255–69. doi: 10.1521/aeap.17.4.253.66529. [DOI] [PubMed] [Google Scholar]
- 18.Plackett RL, Burman JP. The design of optimum multifactorial experiments. Biometrika. 1946;33:305–25. doi: 10.1093/biomet/33.4.305. [DOI] [Google Scholar]
- 19.Crosby RA, Holtgrave DR, Bryant L, Frew PM. Correlates of negative intent to receive an AIDS vaccine: An exploratory study. Int J STD AIDS. 2004;15(8):552–57. doi: 10.1258/0956462041558177. [DOI] [PubMed] [Google Scholar]
- 20.Quinn SC. AIDS and the African American woman: The triple burden of race, class, and gender. Health Educ Behav. 1993;20(3):305–20. doi: 10.1177/109019819302000303. [DOI] [PubMed] [Google Scholar]
- 21.Bruhier MA, Drover G. Income of Black Women in Canada. Ottawa, ON: Canadian Association of Social Workers; 2005. [Google Scholar]
- 22.Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, et al. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care. 2006;44(11):990–97. doi: 10.1097/01.mlr.0000228021.89490.2a. [DOI] [PubMed] [Google Scholar]
- 23.Frew PM, Crosby RA, Salazar LF, Gallinot LP, Bryant LO, Holtgrave DR. Acceptance of a potential HIV/AIDS vaccine among minority women. J Natl Med Assoc. 2008;100(7):802–13. doi: 10.1016/S0027-9684(15)31374-2. [DOI] [PubMed] [Google Scholar]
- 24.Kakinami L, Newman PA, Lee SJ, Duan N. Differences in HIV vaccine acceptability between genders. AIDS Care. 2008;20(5):542–46. doi: 10.1080/09540120701867180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Boyd M, Pikkov D. Gendering migration, livelihood and entitlements: Migrant women in Canada and the United States. Geneva: United Nations Research Institute for Social Development; 2005. [Google Scholar]
- 26.Marie HL, Barry EC. The UCLA multidimensional condom attitudes scale: Documenting the complex determinants of condom use in college students. Health Psychol. 1994;13(3):224–37. doi: 10.1037/0278-6133.13.3.224. [DOI] [PubMed] [Google Scholar]
- 27.Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81. doi: 10.2105/AJPH.92.3.378. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Eide M, Myhre M, Sundby J, Arimi P, Thior I. Social consequences of HIV-positive woman’s participation in prevention of mother-to-child transmission programmes. Patient Educ Couns. 2006;60(2):146–51. doi: 10.1016/j.pec.2004.11.014. [DOI] [PubMed] [Google Scholar]
- 29.Sayles JN, Wong MD, Cunningham WE. The inability to take medications openly at home: Does it help explain gender disparities in HAAART use? J Women’s Health. 2006;15(2):173–81. doi: 10.1089/jwh.2006.15.173. [DOI] [PubMed] [Google Scholar]