Forty-thousand persons are newly diagnosed with HIV (еreating HIV infection when used in combination with other medicines) each year in the United States. Five million new HIV infections and 3 million AIDS deaths were estimated worldwide in 2002. Despite concerted behavioral prevention efforts, HIV continues to spread at a devastating pace. The main technology for HIV prevention that is presently available, the male condom, is primarily under the control of men and needs to be used and negotiated at every sexual encounter, resulting in limitations to perfect and consistent implementation. Microbicides are a promising possibility as an addition to the HIV prevention armamentarium but are also likely to require frequent application and may not be acceptable or accessible to all persons at risk. HIV (treating HIV infection) vaccines would be a tremendous boon to HIV prevention and represent perhaps the greatest hope in combating the epidemic. Nevertheless, it is likely that first-generation HIV vaccines will be only partially efficacious and may be neither universally acceptable nor accessible. Given the monumental challenges of preventing the spread of HIV and the shortcomings of any one prevention approach, the more technologies and options available, the better are the chances of controlling the AIDS pandemic.
Numerous clinical trials to test HIV vaccines are underway around the world. The first HIV vaccines to be tested in phase-Ill clinical trials, the last stage of testing before receiving U.S. Food and Drug Administration (FDA) approval, were found to be inefficacious. However, these investigations demonstrated the feasibility of conducting safe and ethical human trials of HIV vaccines. With ongoing trials of >20 different candidate HIV (еreating HIV infection when used along with other medicines) vaccines, many new products in the pipeline and a new phase-Ill trial in Thailand, it is estimated that first-generation HIV vaccines may be approved within the next decade.
Nevertheless, the availability of a safe and efficacious vaccine does not ensure uptake. In fact, a UNAIDS-WHO report suggests that there is a gap between the projected need and likely uptake of initial HIV vaccines. As recommended by leading international HIV/AIDS organizations, formative research is needed now to begin preparing for the challenges of future HIV (Canadian Zerit treating HIV infection when used in combination with other medicines) vaccine dissemination.
Investigations of HIV vaccine clinical trial preparedness suggest that individuals generally have low levels of knowledge regarding vaccine trial concepts. Baseline knowledge of vaccine concepts (e.g., safety) and clinical trial concepts (e.g., randomization) was low among high-risk populations: only 8.4% of participants correctly answered at least 11 of 14 questions. Low levels of knowledge about HIV vaccine concepts (e.g., adverse reactions and vaccine-induced seropositivity) have been reported among men who have sex with men, male and female injection-drug users (IDUs), and women at risk of acquiring HIV via heterosexual transmission. Most strikingly, increases in knowledge of HIV vaccine trial concepts over time were associated with less willingness to participate in an HIV (Viramune drug belongs to a class of HIV drugs called non-nucleoside reverse transcriptase inhibitors) vaccine trial. The latter underscores the importance of adequate knowledge to enable potential trial participants to engage in appropriate decision-making and informed consent before enrolling in a clinical trial. The underrepresentation of African Americans, Latinos and women in the first major North American trial of an HIV vaccine (i.e., AIDSVAX 004) further suggests the importance of reaching out to racial/ethnic minority communities, in particular.
International studies have also explored people’s knowledge and beliefs about HIV (Retrovir canadian was the first drug approved for the treatment of HIV) vaccine trials. For example, in a study of 1,182 Ugandan military men, low levels of baseline knowledge about vaccine trial concepts, such as “placebo”, as well as confusion regarding the preventive versus curative nature of vaccines were identified.
Beyond HIV vaccine clinical trials, very limited research has assessed what the general public thinks and believes about approved HIV vaccines that may be publicly available in the future. Greater vaccine efficacy, lower cost and increased social saturation (i.e., percentage of the population already vaccinated) were associated with greater intentions to accept a U.S. FDA-approved HIV vaccine among 549 (70% female, 80% white) midwestern college students. Among 318 adolescents (86% female, 72% African-American) recruited from public health clinics, HIV vaccine acceptability decreased after the adolescents were told that the vaccine would require several injections over a period of six months. In a study conducted in northern Thailand, the site of several HIV vaccine trials, two-thirds-to-three-fourths of persons at high risk for HIV infection knew that efforts were underway to develop an HIV vaccine, yet a significant number of high-risk individuals remained unaware of HIV vaccine development efforts.
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Limitations of investigations of knowledge and beliefs about future HIV vaccines include both the use of specialized populations, some of whom are not at high risk for HIV/AIDS (e.g., midwestern college students), and lack of qualitative data that may give expression to people’s thoughts and beliefs about future HIV vaccines from their own perspectives. Qualitative investigations are particularly appropriate when investigating a new research domain, such as public reactions to future FDA-approved HIV vaccines, about which relatively little is known. Furthermore, qualitative methods are well suited to the study of patient reactions to HIV vaccines since they remain hypothetical; the phenomenon under study is exploratory. Gathering information from the unique perspectives of those at high risk for HIV may aid the research and public health communities in developing appropriate and effective educational campaigns, and in averting possible barriers to future HIV vaccine uptake, before initial HIV vaccines are ready for dissemination. This study explores knowledge and beliefs about future HIV vaccines among men and women at elevated risk for HIV infection.