Message that motivate: COVID-19 and monkeypox vaccine hesitancy.

AIDS United conducted research in 2021 about COVID-19 vaccine hesitancy among people living with and vulnerable to HIV with support from Johnson & Johnson.

Vaccines for the virus that causes COVID-19 had only been available for about six months when the research began, and about 60% of people living in the United States were fully vaccinated at the time. (Update: That number has only grown to 68% as of Aug. 31, 2022.)

AIDS United’s research sought to understand what influenced the decision regarding whether or not to get vaccinated among people living with and vulnerable to HIV. 

A convenience sample of more than 800 people took the survey.

The study found the level of concern about getting COVID-19 was a key difference between people who were vaccinated and those who were not. 

Among those who got the vaccine, 12% reported being unconcerned about COVID-19, and only 1% said they were not at all concerned. The unvaccinated, however, were significantly less likely to be concerned about COVID-19, with 36% saying they were unconcerned and 7% said they were not concerned at all. 

Additionally, the survey asked about motivations to get the vaccine. Vaccinated respondents were asked what were their top motivators and unvaccinated respondents were asked what would be most motivating to them. The top three answers were identical: protecting their personal health, protecting the health of their friends and family, and protecting the health of coworkers.

Taken together, these data suggest that people living with and vulnerable to HIV who have not gotten the vaccine do care about their health and the health of those around them, but did not view COVID-19 as a significant threat. 

Of course, no group is a monolith. Clinicians should always ask probing questions to understand each patient’s unique values, specific concerns and individual health goals. 

Monkeypox update

Monkeypox vaccines were severely limited in the early days of the outbreak. We had a lot of demand and very little supply. The opposite is now true. There are presently plenty of vaccine doses, and not enough people seeking vaccination.  

The Centers for Disease Control and Prevention reports that there have been 28,492 cases of monkeypox as of Nov. 2. While new diagnoses peaked in August and have been steadily declining, monkeypox should remain a concern for gay and bisexual men, especially Black gay and bisexual men, and those of us living with HIV.

For example, Drs. Matthew R. Golden and Judith N. Wasserheit write in The New England Journal of Medicine, “Among U.S. cases for which data are available, 98% have been in people assigned male sex at birth, and 93% have been in gay or bisexual men.” NMAC reports the proportion of cases among Black people is increasing and 80% of those hospitalized for monkeypox were people living with HIV.

While there are many things — including political polarization — that make the COVID-19 pandemic unique, it is likely some lessons apply to other health crises, like the current monkeypox outbreak. 

With that assumption, public messaging should emphasize the risks associated with the disease and the benefits of protecting personal and community health. The risks should include both individualized risk to personal health, but also the risks to friends, family, sexual partners and coworkers. 

As before, in a clinical setting, don’t assume the person doesn’t already know the risks and benefits. Conversations on the individual level should seek to find and discuss an individual’s specific concerns. 

(Editor’s notes: This article was first published in April 2022. We updated it in November to add the section on monkeypox. Funding for this project was provided by Johnson & Johnson, however no one from the pharmaceutical company was involved in any aspect of the project beyond the initial proposal.)