HIV Vaccine Preparedness among Men Who Have Sex with Men in Taiwan: Sociocultural and Behavioral Factors

In Taiwan, men who have sex with men (MSM) account for 60.4% of the over 33,000 people living with HIV, and the proportion of MSM among new HIV infections is increasing. Several trials underway globally build on incremental progress in HIV vaccine development. HIV vaccine awareness, vaccine acceptability, and HIV stigma may be key elements in decisions about HIV vaccination. In order to prepare for the introduction of future HIV vaccines, this study investigated sociocultural and behavioural factors that may influence how the HIV vaccine would be received among MSM in Taiwan.

From July to August 2014, the researchers conducted a cross-sectional survey with MSM recruited through community-based organisations (CBOs) in Taipei and Taichung. Key findings:

• Over two-thirds (69.0%) of the 200 participants indicated being aware of HIV vaccine research or development efforts. In bivariate analyses, greater HIV vaccine awareness was associated with higher education, income, and having more than 1 male sex partner. HIV stigma showed no statistically significant differences in HIV vaccine awareness.
• The over 3-fold higher odds of HIV vaccine awareness among MSM who are current traditional Chinese medicine (TCM) users is a potentially counterintuitive finding, yet there is evidence in East Asian contexts of patients' concurrent use of TCM and Western medicine.
• Less than half of participants (43.8%; excluding people living with HIV, n = 24) reported willingness to use an HIV vaccine if it became available in the future.
• The mean felt-normative stigma score indicates that most MSM reported that at least some people in their community held negative beliefs and attitudes toward people living with HIV (e.g., that they are shameful). The mean vicarious stigma score indicates that many MSM reported hearing stories about mistreatment and social exclusion of people living with HIV. Although HIV stigma was not significantly associated with HIV vaccine awareness or acceptability, the prevalence of HIV stigma among this predominantly HIV-negative sample of MSM is concerning.

Implications:

• Both TCM and Western medical practitioners may lack competencies in working with sexual minority populations, requiring further training in order to effectively support HIV vaccine awareness.
• Tailoring HIV vaccine educational efforts to communicate about HIV vaccines with MSM with lower levels of education may help to broaden awareness.
• HIV vaccine education and awareness initiatives for MSM in Taiwan might benefit from supporting accurate perceptions of the disproportionate HIV risk among MSM and by emphasising the potential role of HIV vaccines and other new prevention technologies as part of combination prevention.

In conclusion, with disproportionate HIV prevalence among MSM in Taiwan, the findings suggest cultural opportunities and challenges for supporting HIV vaccine preparedness, including the pivotal role of CBOs serving MSM amidst high levels of HIV stigma and the importance of building on complementary use of TCM and Western medicine.