Medical mistrust and vaccine-hesitant attitudes explain SARS-CoV-2 vaccination disparities in a mixed-serostatus cohort

Abstract

Objectives: 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.

Design: Quantitative data analyses in a racially and gender diverse, mixed-serostatus prospective cohort, the MACS/WIHS Combined Cohort Study.

Methods: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021-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 a) medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and b) vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination.

Results: 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 non-vaccination than white participants (aOR = 1.72; 95% CI: 1.08, 2.72). Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46.0% of the effect (p < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination 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.

Conclusions: Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the U.S, including those affected by HIV.