Potential influence of HIV vaccine understanding on MSM risk reduction decisions

Objective: Models have suggested that risk compensation due to a low-efficacy HIV vaccine could exacerbate HIV transmission rates. Trends in vaccine research suggest that a low-efficacy vaccine may be the first available HIV immunization. Correct understanding of low efficacy would be important for risk reduction decisions, yet it is unknown whether the public understands the efficacy concept. This exploratory study sought to understand how men who have sex with men (MSM) would incorporate an HIV vaccine into current risk reduction practices based on understanding of HIV vaccines.

Methods: MSM in the San Francisco Bay Area were interviewed about their perceptions of HIV vaccines. Nineteen participants were recruited from venues frequented by MSM. The analysis employed qualitative methodology, using an adapted grounded theory approach to develop themes about understanding and interest in HIV vaccines.

Results: Participant criteria for acceptable vaccine efficacy appeared to be arbitrary, suggesting that self-assessment for sexual risk was not based on epidemiologic understanding of HIV risk and was potentially unrealistic. Furthermore, high-risk MSM listed uses for an HIV vaccine that indicate the potential for risk compensation. High-risk MSM reported a desire to avoid discussion of HIV status and a desire to have more unprotected sex, sex with anonymous partners, and sex with riskier partners.

Conclusions: As an exploratory study, further research is needed to determine the prevalence of these attitudes among MSM. However, the results do suggest that improved HIV vaccine education is needed as part of any HIV vaccine intervention.