HIV Vaccination among High-risk Drug Users in Appalachia: Insights from Social Network Analysis on Feasibility, Consequences, and Dissemination Strategies Open Access

Abstract

A preventive HIV vaccine could substantially impact the epidemic, but high uptake, effective dissemination, and continued promotion of behavioral risk reduction will be necessary. Research suggests that low vaccine uptake and risk compensation (e.g. increased risk behavior after vaccination) are possible. However, there are notable gaps in the literature. Rural, drug-using populations have been significantly underrepresented and risk compensation related to syringe sharing has been under-studied. Moreover, no research to date has examined the potential impact of risk compensation on risk network structure. Thus, the secondary analyses for this dissertation address important gaps in the extant literature, as they provide a comprehensive individual- and network-level examination of HIV vaccine acceptability, risk compensation, and peer-based vaccine promotion among a sample of high-risk drug users from rural Appalachia. Study 1 examined demographic, behavioral, and psychosocial correlates to HIV vaccine acceptability. Findings indicated that vaccine acceptability was lower among men, but higher among those who believed they were susceptible to HIV, that a vaccine could benefit them, and who had positive perceived social norms. Study 2 explored network-level correlates to willingness to encourage HIV vaccination among risk network members. The study showed that vaccine promotion was more likely when the partner was perceived to be at high-risk for HIV, willing to accept the vaccine, and likely to reciprocate the encouragement. Encouragement was also more common in relationships involving intended risk compensation. In Study 3, network-level correlates to and consequences of risk compensation were explored. Intent to engage in risk compensation was rare, but was more common in relationships of shorter duration. A risk network constructed based on intended risk compensation revealed that risk network structure would increase in connectivity, although only minimally. These analyses demonstrate that HIV vaccine acceptability is high among this sample of rural drug users and that peer-based vaccine promotion may be feasible. However, peer-based strategies should be approached cautiously, as promotion may be associated with intent to engage in risk compensation. Further research in this and other populations is needed to explore the role that drug users' social networks could play in vaccine uptake, dissemination, and risk compensation.

Table of Contents

Chapter 1 : Introductory Literature Review............................................................. 1 HIV Vaccination............................................................................................................ 1 HIV Vaccine Acceptability........................................................................................... 2

Social Influences on HIV Vaccine Acceptability.................................................. 12

Risk Compensation................................................................................................... 17

Underrepresentation of People who Use Drugs in HIV Vaccine Acceptability Research 23

HIV Vaccine Acceptability among High-risk Populations in Rural Areas........ 25

Significance of Dissertation Research................................................................... 27

Summary...................................................................................................................... 28 References.................................................................................................................. 30

Chapter 2 :HIV vaccine acceptability among high-risk drug users living in a rural, low-prevalence community..................................................................................................................... 55

Introduction................................................................................................................. 56 Methods....................................................................................................................... 59 Results......................................................................................................................... 66 Discussion................................................................................................................... 71 References.................................................................................................................. 84

Chapter 3 : Drug users' willingness to encourage social, sexual, and drug network members to receive an HIV vaccine: A social network analysis............................................. 95

Introduction................................................................................................................. 96 Methods....................................................................................................................... 99 Results....................................................................................................................... 106 Discussion................................................................................................................ 110 References................................................................................................................ 121

Chapter 4 :Will HIV Vaccination Reshape HIV Risk Behavior Networks? A Social Network Analysis of Drug Users' Anticipated Risk Compensation................................................ 129

Introduction............................................................................................................... 130 Methods..................................................................................................................... 134 Results....................................................................................................................... 143 Discussion................................................................................................................ 147 References................................................................................................................ 159 Chapter 5 : Conclusion............................................................................................ 169 References................................................................................................................ 178

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral Health Sciences, Epidemiology
Keyword	risk compensation social network analysis HIV vaccine drug use rural behavior attitude acceptability
Committee Chair / Thesis Advisor	Diclemente, Ralph Joseph, Emory University
Committee Members	Halgin, Daniel S., University of Kentucky Cooper, Hannah, Emory University Jennifer R., Havens, University of Kentucky Sterk, Claire E, Emory University

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