Illustration by Sasha Plotnikova/Torontoist.
The International AIDS Conference in Austria two weeks ago served as a reminder that a vaccine for HIV remains in desperate demand across the globe. Yet a new research paper by University of Toronto professor Peter A. Newman and graduate student Carmen Logie says that even if a perfectly effective vaccine were created, over a quarter of Canadian and U.S. residents would choose not to use it.
Newman, who is currently an associate professor at U of T’s Faculty of Social Work and a Canada Research Chair, along with Social Work PhD candidate Logie, reviewed more than thirty quantitative and qualitative studies that surveyed individuals throughout North America. The paper, which was published this month in AIDS, the official journal of the International AIDS Society, analyzes the surveys of more than twelve thousand people, including those deemed at higher risk for HIV such as ethnic minorities, injection drug users, and men who have sex with men.
The potential effectiveness of a vaccine played a major role in the choice of many individuals, Newman says. “People are much more likely to take a vaccine if it’s highly effective, and are much less likely to if its [success] rate is 50%, even though on a population level that would knock the disease down significantly.” If a 50%-effective vaccine existed, only 40% of people surveyed would choose to be vaccinated (compared to the 74% who would if it was totally effective).
While fears about the dangers of vaccines were a factor, “the bottom line is it’s totally impossible for anyone to get HIV with a vaccine [if developed],” Newman says. “There would not be live HIV in the vaccine.” However, Newman and Logie’s analysis found that structural factors, such as availability and accessibility, also had a significant effect. “These practical obstacles are so important because there’s a lot [when dealing with vaccination] that’s out of our control, but these are things that are,” he adds. Newman highlights the importance of making the vaccine as readily available as possible and integrating it into the health care system. For example, making it available at the regular doctor’s office would de-stigmatize the vaccine by eliminating that unwanted walk into an AIDS clinic. According to Logie, other deterrents could include high cost, transportation, clinic locations, and hours of operation.
Newman saw parallels between people’s reactions in his study and the vaccination campaign during Ontario’s H1N1 scare last winter. “It’s even hard to get the flu vaccine to all the people who need it—we saw that with H1N1, and that’s an extraordinarily low-risk vaccine,” he says. Despite public health warnings and campaigns, the lack of quick access and availability of the vaccine led to a mere 32% of Ontarians getting the shot. And two weeks ago, reports emerged that those who did get the vaccine helped prevent an estimated fifty deaths and one hundred thousand visits to doctors’ offices.
Beyond issues of effectiveness and accessibility, Newman and Logie’s research found that many subjects said they would refuse the vaccination simply because they didn’t view themselves as at risk for HIV infection, even if they belonged to a statistically high-risk group. “When people felt that they did not belong to a risk group it was significantly related to lower acceptability [of the vaccine], while people who perceived that they were at risk were positively associated with vaccine acceptability,” Logie says. She also reiterates that everyone remains at risk for HIV to some degree, while Newman notes that even serial monogamy is a “risky behaviour” when it comes to exposure.
The problem, says Newman, is that we’re more complacent about HIV and AIDS than we were several decades ago. “It’s not as big on our agenda due to ‘treatment optimism’—we have medication and people can live a long life, but we often don’t see the horrible side effects of those medications and forget that they are extraordinarily expensive,” he says. “[The treatments] take infection out of the realm of the freak-out, but unfortunately what happens is new rates of infections start to go up again, especially for gay men in Canada and adolescents across North America.” In Toronto, data from 2008 found that 558 residents were diagnosed as positive, while 58% of all positive Ontario test reports occurred in Toronto.
If and when a vaccine is developed and comes to Toronto, Newman suspects we won’t be ready for it. In the meantime, Logie recommends an emphasis on community-based education. “The government could play a big role in working with marginalized communities to educate people about the vaccine, make sure that when it comes out they are addressing all the structural obstacles of accessibility,” she says. Adds Newman: “We will need to demystify the vaccine. People may have questions and fears about it, and it’s important to respect their questions and to respond in a reasonable way, since education is a big part of this.”
The name of the University of Toronto professor whose study formed the basis for this article is Peter A. Newman—not, as we mistakenly wrote initially, Paul A. Newman.