Friedman M Reuel, Wingood Gina, Krause Kristen D, Krier Sarah, D'Souza Gypsyamber, Kempf Mirjam-Colette, Mimiaga Matthew J, Kwait Jenn, Jones Deborah L, Martinson Jeremy, Marques Ernesto T, Tien Phyllis, Anastos Kathryn, Ramirez Catalina, Cohen Mardge, Camacho-Rivera Marlene, Goparaju Lakshmi, Rinaldo Charles R
Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ.
Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA.
AIDS. 2025 Feb 1;39(2):193-203. doi: 10.1097/QAD.0000000000004053. Epub 2024 Nov 4.
To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities.
Quantitative data analyses in a racially and gender-diverse, mixed-serostatus prospective cohort, the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study.
Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021 to September 2022 ( n = 3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination.
Participants' mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of White participants). Black-identified participants had higher odds of nonvaccination than White participants [aOR = 1.72; 95% confidence interval (CI) 1.08-2.72]. Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46% of the effect ( P < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination to the extent that 57.7% (95% CI 25.3-90.1%) of the disparity would be eliminated if vaccine-hesitant attitudes among Black respondents were reduced to levels reported among other racial groups.
Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the United States, including those affected by HIV.
了解感染新冠病毒2型（SARS-CoV-2）的艾滋病毒感染者（PWH）及易感染艾滋病毒人群中种族差异的程度，并评估医疗不信任和疫苗犹豫态度对这些差异的影响。
在一个种族和性别多样化、血清学状态混合的前瞻性队列——多中心艾滋病队列研究（MACS）/女性机构间艾滋病毒研究（WIHS）联合队列研究中进行定量数据分析。
由访员协助的问卷在2021年3月至2022年9月期间评估了SARS-CoV-2疫苗接种情况、医疗不信任和疫苗犹豫态度（n = 3948）。纵向分析评估了社会人口统计学对医疗不信任和疫苗犹豫态度的影响。分层多变量逻辑回归评估了这些共同因素对SARS-CoV-2疫苗接种的影响。因果中介模型评估医疗不信任是否介导了黑人身份与疫苗犹豫态度之间的关系，以及疫苗犹豫态度是否介导了黑人身份与未接种SARS-CoV-2疫苗之间的关系。
参与者的平均年龄为56.7岁；55.3%为黑人，52.6%为顺性别女性，62.6%为PWH。10.1%的人报告从未接种过SARS-CoV-2疫苗（黑人参与者中占13.4%，白人参与者中占4.5%）。自我认定为黑人的参与者未接种疫苗的几率高于白人参与者 [调整后比值比（aOR）= 1.72；95%置信区间（CI）1.08 - 2.72]。医疗不信任介导了黑人身份与疫苗犹豫态度之间的关系，占该影响的46%（P < 0.0001）。疫苗犹豫态度介导了黑人身份与未接种SARS-CoV-2疫苗之间的关系，即如果黑人受访者的疫苗犹豫态度降低到其他种族群体报告的水平，57.7%（95% CI 25.3 - 90.1%）的差异将被消除。
研究结果表明，迫切需要建立值得信赖的医疗环境，以消除美国黑人社区（包括受艾滋病毒影响的社区）中的医疗不信任和疫苗犹豫态度。
