Willingness to receive COVID-19 vaccination among people living with HIV and AIDS in China: A nationwide cross-sectional online survey.

BACKGROUND: HIV infection is a significant independent risk for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. OBJECTIVE: This study investigated willingness to receive COVID-19 vaccination among a national sample of PLWHA. METHODS: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18-65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBO) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aOR), which involved one of the independent variables of interest and all significant background variables. Path analysis were also used in data analysis. RESULTS: Out of 10,845 PLWHA approached by the CBO, 2740 completed the survey, and 170 had received at least one dose of COVID-19 vaccination. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (57.2%, 1470/2570). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR: 1.11, 95%CI: 1.09, 1.12, P<.001), negative attitudes (aOR: 0.96, 95%CI: 0.94, 0.97), perceived support from significant others (perceived subjective norm) (aOR: 1.53, 95%CI: 1.46, 1.61), and perceived higher behavioral control (aOR: 1.13, 95%CI: 1.11, 1.14). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR: 1.99, 95%CI: 1.65, 2.40), CBO staff (aOR: 1.89, 95%CI: 1.51, 2.36), friends and/or family members (aOR: 3.22, 95%CI: 1.93, 5.35), and PLWHA peers (aOR: 2.38, 95%CI: 1.85, 3.08) were associated with higher willingness to receive COVID-19 vaccination. Overall opinion supporting COVID-19 vaccination for PLWHA on Internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR: 1.59, 95%CI: 1.31, 1.94). Path analysis indicated that interpersonal-level variables was indirectly associated with willingness to receive COVID-19 vaccination through perceptions (s=0.43, 95% CI=0.37, 0.51, P<.001). CONCLUSIONS: As compared to PLWHA in other countries and general population in most part of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. Internet/social media and interpersonal communications may be a major source of influence on PLWHA's perceptions and willingness to receive COVID-19 vaccination.