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Epidemiology and Social

HIV vaccine acceptability: a systematic review and meta-analysis

Newman, Peter A; Logie, Carmen

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doi: 10.1097/QAD.0b013e32833adbe8
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Results from the Thai Phase III HIV vaccine study (RV144), the largest HIV vaccine trial conducted to date, have demonstrated for the first time that a vaccine can prevent HIV infection [1]. The modest protective effect of the experimental vaccine, while not sufficient for licensure, represents a significant step in ongoing HIV vaccine development efforts [1–3].

A vaccine would obviate many of the social and behavioral challenges of existing HIV preventive interventions, e.g., the need to correctly and consistently implement and negotiate condom use at each sexual encounter. Nevertheless, HIV vaccine acceptability, that is, potential users’ judgments of the satisfactoriness of future HIV vaccines and willingness to use them, is not guaranteed. Challenges related to HIV vaccine acceptability and access portend a broad gap between projected need and actual uptake of future HIV vaccines [4–6]. The extent to which we can close this gap will be key to the success of HIV vaccines in controlling the epidemic.


The objective of this systematic review is to synthesize results from over a decade of quantitative and qualitative investigations of HIV vaccine acceptability. Acceptability is based on hypothetical HIV vaccines that may be available in the future; at present there is no HIV vaccine approved for public licensure. Specifically we aim to understand: (1) rates of HIV vaccine acceptability; and (2) factors that may impact HIV vaccine acceptability.


Criteria for considering studies for this review

Types of studies included in this review include original research studies using qualitative, quantitative, or mixed methods design. Studies must have examined rates of HIV vaccine acceptability and/or barriers, facilitators, attitudes, socio-demographic characteristics, or other factors that impact acceptability of future HIV vaccines. Only studies published in peer-reviewed journals were included, with no language, geographical, or time restriction. Studies that did not use quantitative or qualitative methods, report original data, or focus on HIV vaccine acceptability were not included in this review. Types of participants included youth and adults reporting on HIV vaccine acceptability for themselves, others, or their children.

Outcome measures

The primary outcome is HIV vaccine acceptability rates. The secondary outcomes are factors that impact HIV vaccine acceptability, including demographic characteristics (i.e., ethnicity), vaccine characteristics (i.e., efficacy), HIV vaccine attitudes (i.e., perceived benefits), HIV risk perceptions (i.e., perceived susceptibility), social factors (i.e., HIV stigma), and structural factors (i.e., HIV vaccine cost).

Search methods for identification of studies

We used a comprehensive search strategy to locate articles meeting the inclusion criteria across multiple electronic databases: ScholarsPortal, *MedLine, *Campbell Collaboration, *Cochrane Library, PsychInfo, ERIC, Social Work Abstracts, Dissertations Abstracts, and *OVID. The search strategy had no date/time restriction and included the terms HIV, AIDS, vaccine, accept*, attitude, uptake, barriers, and facilitators. We identified studies reviewed in this article by searching the databases using the designated terms and by searching references cited in peer-reviewed articles.

Data collection and analysis

Selection of studies

All titles and abstracts from the reference lists of articles were screened for inclusion. The full article was obtained when the first reviewer determined the article might meet inclusion criteria based on the objectives of the study. Once the shortlisted studies were compiled, two reviewers (P.A.N., C.L.) assessed each article for inclusion based on study type and outcome measures. Each article was independently reviewed and reviewers provided a summary statement describing reasons for exclusion. In case of disagreement, a third reviewer was available to arbitrate.

Data extraction and management

We developed a data extraction form using Microsoft Excel. The following data were extracted independently by two reviewers: article information (i.e., year of publication, author, journal); descriptive data (i.e., sample size, country, participant demographics); methods and study design; and outcomes/key findings.

Analysis of outcome measures

For studies that quantified HIV vaccine acceptability, we linearly transformed acceptability ratings onto a 0–100 scale. We further identified studies that provided acceptability ratings for both highly (80% – 95%) and partially (50%) efficacious hypothetical HIV vaccines, and conducted a paired sample t-test to assess statistically significant differences.

Based on a review of the articles, we developed a list of themes and subthemes related to vaccine acceptability. We reviewed each article several times to ensure findings were catalogued under relevant themes. To reduce bias and ensure that studies reported in several articles were not overrepresented, we included themes and acceptability scores from only one article per study.

Data synthesis

We conducted meta-analysis on studies that examined similar correlates or predictors of HIV vaccine acceptability. Version 2 of Comprehensive Meta-Analysis Software [7] was used to calculate effect sizes for each variable with a random effects model to compensate for clinical and methodological diversity between studies.

We combined coefficients across studies for each variable that was examined to derive a global estimate of its correlation with HIV vaccine acceptability [8]. We examined factors associated with HIV vaccine acceptability categorized according to the themes identified in the literature review. We calculated the Q statistic to assess homogeneity of correlations across studies [9] and the I2 index to assess the degree of heterogeneity [10].

All studies examining correlates of HIV vaccine acceptability that provided sufficient data (i.e., correlations, odds ratios, chi squared statistics, or t-values) were included in meta-analysis. We contacted corresponding authors, as needed, to provide missing and unreported data (e.g., group means, standard deviations, confidence intervals, sample sizes, demographics) to facilitate inclusion in meta-analysis. As no studies evaluated interventions to enhance HIV vaccine acceptability, we did not conduct meta-analysis on dichotomous (intervention vs. control group) data.

We then quantified and ranked each theme and subtheme based on its prevalence across studies. Fisher's exact test was used to assess significant differences between subthemes found in qualitative and quantitative articles, and independent sample t-tests to assess statistically significant differences between overall themes explored in qualitative versus quantitative articles.


Results of the search

The systematic literature search yielded 186 studies (see Fig. 1), with 100% agreement between reviewers in selecting relevant articles (n = 52). Of the relevant studies, 13 were excluded because they did not include original research results; did not examine barriers, facilitators, or attitudes regarding acceptance of future HIV vaccines; or did not focus on HIV vaccine acceptability. Thirty-nine remaining studies, 21 quantitative and 18 qualitative, were included in this analysis.

Fig. 1:
Flow diagram of selection process for HIV vaccine acceptability review.

Included studies

Both authors reviewed articles to determine whether the same sample and study were used more than once. We identified 30 original studies (n = 11 711) that are included in the final analysis. The 21 quantitative articles [5,11–30] reflect 18 original studies [5,11–13,15,16,18–20,22–30] (n = 11 155). The 18 qualitative articles [31–48] reflect 12 original studies [31,33–37,39,41,42,45,48] (n = 556). All studies included in this review (n = 30) were published in English. Studies were conducted in seven countries: the United States (n = 21), Canada (n = 2), South Africa (n = 2), Uganda (n = 2), the Dominican Republic (n = 1), Thailand (n = 1), and Vietnam (n = 1).

We identified seven major themes across the 30 studies: (1) demographic factors; (2) vaccine characteristics; (3) HIV risk perceptions; (4) HIV vaccine attitudes; (5) behavioral factors; (6) social factors; and (7) structural factors.

Quantitative studies

Quantitative methods included structured questionnaires that were self-administered (n = 10), interviewer-administered (n = 6), and administered by telephone (n = 2). Two self-administered and two interviewer-administered surveys were computer assisted. Sampling methods included: random sampling (n = 3); stratified random sampling (n = 3); venue-based sampling (n = 2); and convenience sampling (n = 10). Quantitative study samples included: adults at elevated risk for HIV infection [i.e., men who have sex with men (MSM), injection drug users (IDUs), low socioeconomic African Americans and Latinos, prison inmates] (n = 6); college students (n = 4); adolescents (n = 3); adults from the general population (n = 2); parents and their adolescent child (n = 1); healthcare practitioners (n = 1); and military personnel (n = 1).

Qualitative studies

Qualitative methods included semi-structured interviews (n = 7) and focus groups (n = 5). Sampling methods included: venue-based (n = 5), convenience (n = 4), snowball (n = 2), and online recruitment (n = 1). The sample composition for the qualitative studies included: high-risk adults (i.e., STD clinic attendees, MSM, IDUs, female sex workers) (n = 6), adolescents/young adults (n = 2), the general population (n = 2), parents (n = 1), and U.S. immigrants (n = 1).

HIV vaccine acceptability

Twenty-one studies published between 1996 and 2010, with sample sizes ranging from 14 to 1615, quantified HIV vaccine acceptability (see Table 1). Twenty studies (n = 7576) were included in the calculation of HIV vaccine acceptability scores because two studies [20,21] were based on the same sample. These 20 investigations were conducted among high-risk adults (i.e., STD clinic attendees, U.S. ethnic minorities at elevated risk of infection, MSM, prison inmates) (n = 6), college students (n = 4), adolescents (n = 4), parents (n = 2), adults in the general population (n = 2), military personnel (n = 1), and Asian and Pacific Islanders in the United States (n = 1).

Table 1:
HIV vaccine acceptability, study populations, countries and sample sizes (n = 20).

HIV vaccine acceptability ranged from 37.2 to 94.0 on a 100-point scale, with a mean acceptability of 65.3 (SD = 20.0). The weighted mean HIV vaccine acceptability score was 65.6 (SD = 21.1).

Eleven studies [12,18,19,21,23,24,26,29,35,40,47] compared HIV vaccine acceptability at high (80–95%) versus moderate (50%) efficacy. Mean acceptability at high efficacy was 73.8 (SD = 9.2) versus 40.4 (SD = 20.2) at moderate efficacy (t(9) = 4.97, P < 0.001).

Meta-analytic results: correlates of HIV vaccine acceptability

Sufficient data were provided to examine the association between HIV vaccine acceptability and factors in five categories: vaccine characteristics, structural factors, HIV risk perceptions, HIV vaccine attitudes, and demographic factors. Table 2 reports weighted mean correlational effect sizes measuring associations of each factor with HIV vaccine acceptability and 95% confidence intervals, as well as the Q test of homogeneity and I2 index of between-study variability. Thirteen studies (n = 5023) were included in the meta-analysis [5,13,15,17,19,20,23–29].

Table 2:
Meta-analysis of HIV vaccine acceptability correlates (n = 13).

The I2 index estimates the percentage of total variability in effect sizes due to between-study variability rather than sampling error; guidelines provided by Higgins and Thompson [49] indicate I2 values of 25% represent low, 50% medium, and 75% high heterogeneity. Based on these guidelines, there is high heterogeneity in the reported correlations between HIV vaccine acceptability and cost, efficacy, ethnicity, side effects/safety concerns, perceived vaccine benefits, fear of vaccines, duration of protection and pragmatic obstacles, and moderate heterogeneity among fear of needles/needle-administered vaccine and perceived susceptibility to HIV infection. Non‘risk group’ membership was a consistent correlate across studies.

To account for between-study variability, we used a random effects model in the meta-analysis. As the small number of studies examining each factor precluded sub-analysis of moderator variables, we examined individual results to identify potential reasons for between-study variability. Substantive (i.e., participant characteristics) and methodological (i.e., study design, sample size, sampling strategy) differences may have impacted between-study variability.

Among the four vaccine characteristics, acceptability was positively correlated with efficacy (r = 0.36, P < 0.001) and duration of protection (r = 0.16, P < 0.01) and negatively correlated with side effects/safety concerns (r = −0.21, P < 0.001) and fear of needles/needle-administered vaccine (r = −0.12, P < 0.05).

Structural factors associated with HIV vaccine acceptability were pragmatic obstacles (r = −0.29, P < 0.01) and cost (r = −0.28, P < 0.05). HIV risk perceptions associated with HIV vaccine acceptability were non‘risk group’ membership (r = −0.32, P < 0.001) and perceived susceptibility to HIV infection (r = 0.26, P < 0.001).

HIV vaccine attitudes associated with HIV vaccine acceptability were fear of vaccines (r = −0.20, P < 0.05) and perceived vaccine benefits (r = 0.17, P < 0.05).

Ethnicity was the only demographic variable significantly associated with HIV vaccine acceptability; being African American (in reference to white) was negatively associated with HIV vaccine acceptability (r = −0.13, P < 0.05).

Efficacy and non‘risk group’ membership had medium effect sizes on HIV vaccine acceptability, based on Cohen's [50] classification. Pragmatic obstacles, cost, perceived susceptibility to HIV infection, side effects/safety concerns, fear of vaccines, perceived vaccine benefits, duration of protection, ethnicity, and fear of needles/needle-administered vaccine had small effect sizes on acceptability.

Comparison between quantitative and qualitative investigations

Themes examined across the 18 quantitative and 12 qualitative original studies are identified in Table 3 in descending order of prevalence.

Table 3:
Prevalence of determinants of HIV vaccine acceptability and comparison between qualitative and quantitative investigations (n = 30).

HIV vaccine characteristics was the most prominent theme across studies, referenced 75 times, with efficacy (n = 19), side effects/safety concerns (n = 17), and fear of vaccine-induced infection (n = 14), the most prevalent subthemes. HIV risk perceptions were evidenced 35 times: perceived vulnerability to HIV infection (n = 14), identification as a member of a risk group (n = 12), and perceived severity of AIDS (n = 9). Additional themes were demographics (n = 33), structural factors (n = 33), HIV vaccine attitudes (n = 31), social factors (n = 30), and behavioral factors (n = 28).

Across the seven thematic categories associated with HIV vaccine acceptability, social factors were examined at a significantly greater frequency in qualitative (n = 17) versus quantitative (n = 8) studies (t(8) = 3.46, P < 0.01). No other statistically significant differences in themes were found between quantitative and qualitative investigations.

Comparisons on the various subthemes using 2×2 contingency tables indicated that risk compensation (n = 9 vs. n = 4, P < 0.01), mistrust and conspiracy (n = 6 vs. n = 1, P < 0.01), perceived behavioral control (n = 5 vs. n = 1, P < 0.05), and the need for vaccine information (n = 8 vs. n = 3, P < 0.05) were significantly more likely to be studied in qualitative vs. quantitative investigations. Three sub-themes assessed in quantitative investigations were not examined in qualitative studies: pragmatic obstacles (n = 6), sexual orientation (n = 2), and healthcare provider attitudes (n = 1).


This systematic review reveals a moderate level of HIV vaccine acceptability (65.6 on a 100-point scale) across 20 studies totaling 7576 participants, with a wide range of acceptability (37.2–94.0) across studies. Overall, the significantly lower acceptability (40.4 vs. 73.8) of moderately (50%) versus highly (80%–95%) efficacious hypothetical HIV vaccines raises cause for concern, given the likelihood that initial HIV vaccines may be of low to moderate efficacy [3].

Meta-analysis results across 13 studies (n = 5023) indicate the primacy of HIV vaccine efficacy among an array of vaccine-specific, demographic, social, and structural factors on ratings of HIV vaccine acceptability. As public health officials may have little control over the level of efficacy of initial HIV vaccines, it will be important to develop evidence-informed public education and social marketing campaigns to increase the acceptability of partially efficacious HIV vaccines [51,52]. In fact, the lower the efficacy of initial HIV vaccines, the more crucial it becomes to achieve high levels of coverage in order to confer herd immunity [53]. To that end, it is also important to identify other modifiable correlates of acceptability.

The significant impact of self-identification as a member of a risk group and perceived susceptibility to HIV infection on HIV vaccine acceptability in the meta-analysis suggests potentially modifiable factors beyond vaccine characteristics that may influence uptake. Other modifiable factors revealed in the meta-analysis include cost and pragmatic obstacles, among the most significant correlates of HIV vaccine acceptability. Structural interventions to subsidize out-of-pocket vaccine cost and facilitate access by addressing pragmatic obstacles (e.g., providing free transportation to clinics, promoting access through local clinics) may be important measures to facilitate broad HIV vaccine uptake.

A small but significant difference was observed in the lower HIV vaccine acceptability among African Americans versus whites, although based on only 2 studies. In fact, few studies measured or reported associations between HIV vaccine acceptability and age (n = 4), gender (n = 4), race/ethnicity (n = 3), sexual orientation (n = 2), or socioeconomic status (n = 0). Future investigations should explore the impact of sociodemographic characteristics on HIV vaccine acceptability, which may provide evidence to support tailored social marketing interventions to increase HIV vaccine uptake [51,52].

Another notable feature of this review is that over three-quarters (76.7%) of investigations of HIV vaccine acceptability were conducted in North America. Only three of 39 studies were conducted in sub-Saharan Africa, which suffers the highest global burden of HIV and might benefit greatly from even a partially efficacious vaccine [54]. Modifiable structural factors, such as cost and pragmatic obstacles, may be expected to exert a strong influence on HIV vaccine uptake in resource-limited settings [55]. Additionally, risk perceptions [56] and vaccine attitudes [55] associated with HIV vaccine uptake may vary as a function of culture and the severity of the epidemic, suggesting the importance of assessing local determinants of HIV vaccine acceptability, particularly in high–HIV prevalence low- and middle-income countries.

Limitations to this review include the absence of intervention studies inherent in evaluating the acceptability of a future (i.e., hypothetical) product and the relatively small number of studies conducted. The lack of intervention studies precludes using RevMan 5 for meta-analyses or application of Cochrane guidelines for assessing risk of bias for experimental and/or observational intervention studies. However, we systematically recorded sampling methods and research design to denote limitations to generalizability, and we calculated weighted mean scores and used a random effects model for the correlational meta-analysis. We also included both qualitative and quantitative studies to increase the breadth of the findings. An additional limitation is that the specific characteristics, cost and time frame for availability of approved HIV vaccines, are at best moving targets. As a result, the current stage of HIV vaccine acceptability research takes place in a dynamic and uncertain field; nevertheless, it constitutes an important contribution to the effectiveness of future HIV vaccines and to further acceptability studies that might be conducted in clinical trial and postmarketing stages [57] of HIV vaccine development.

The acceptability of future HIV vaccines is fundamental to their effectiveness [51]. Given the sustained, large-scale financial investment required for HIV vaccine development, as well as the tremendous costs of lifetime HIV treatment, it may be prudent to pursue relatively low cost acceptability and other social science research in conjunction with basic and clinical HIV vaccine science [51,52]. With an estimated 2.7 million new HIV infections globally in 2008 alone [58], each year of delay in dissemination of future HIV vaccines will result in millions of new infections that might otherwise have been averted.


This review was supported by grants from the Social Sciences and Humanities Research Council, the Ontario HIV Treatment Network, and the Canada Research Chairs Program.

A poster based on an earlier version of this manuscript was presented at AIDS Vaccine 2009 in Paris (19–22 October), with an abstract published in Retrovirology 2009; 6(Suppl 3):P212. doi: 10.1186/1742-4690-6-S3-P212.

P.A.N. conceptualized the study, collaborated in reviewing articles and led writing of the manuscript. C.L. reviewed individual articles, executed the meta-analysis and contributed to writing the manuscript.


1. Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, Kaewkungwal J, Chiu J, Paris R, et al.Vaccination with ALVAC and AIDSVAX to prevent HIV-1 Infection in Thailand.N Engl J Med 2009; 361:2209–2220.
2. Dolin R. HIV vaccine trial results - an opening for further research.N Engl J Med 2009; 361:2279–2280.
3. Fauci AS, Johnston MI, Dieffenbach CW, Burton DR, Hammer SM, Hoxie JA, et al. HIV vaccine research: the way forward. Science 2008; 321:530–532.
4. Esparza J, Osmanov S. HIV vaccines: a global perspective. Curr Mol Med 2003; 3:183–193.
5. Newman PA, Lee SJ, Duan N, Rudy E, Nakazono TK, Boscardin J, et al. Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (L.A. VOICES). Health Serv Res 2009; 44:2167–2179.
6. Hu DJ, Vitek CR, Bartholow B, Mastro TD. Key issues for a potential human immunodeficiency virus vaccine. Clin Infect Dis 2003; 36:638–644.
7. Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis, a computer program for meta analysis. pp. 1–8. 2005. [Accessed 19 November 2009]
8. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Eggar M, Smith GD, Altman DG, editors. Systematic reviews in healthcare: meta-analysis in context. 2nd ed. London: BMJ Books; 2001. pp. 285–312.
9. Streiner DL. Meta-analysis: a 12-step program. Electron J Gambl Issues 2003; 1. (Accessed 19 November 2009)
10. Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 2006; 11:93–206.
11. Allen MA, Liang TS, La Salvia T, Tjugum B, Gulakowski RJ, Murguia M. Assessing the attitudes, knowledge and awareness of HIV vaccine research among adults in the United States. J Acquir Immune Defic Syndr 2005; 40:617–624.
12. Bishai D, Pariyo G, Ainsworth M, Hill K. Determinants of personal demand for an AIDS vaccine in Uganda: contingent valuation survey. Bull World Health Organ 2004; 82:652–660.
13. Crosby RA, Holtgrave DR, Bryant L, Frew PM. Factors associated with the acceptance of an AIDS vaccine: an exploratory study. Prev Med 2004; 39:804–808.
14. Crosby RA, Holtgrave DR, Bryant L, Frew PM. Correlates of negative intent to receive an AIDS vaccine: an exploratory study. Int J STD AIDS 2004; 15:552–557.
15. Gagnon M, Godin G. Young adults and HIV vaccine: determinants of the intention of getting immunized. Can J Public Health 2000; 91:432–434.
16. Hom DL, Johnson JL, Mugyenyi P. HIV-1 risk and vaccine acceptability in the Ugandan military. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 15:375–380.
17. Kakinami L, Newman PA, Lee SJ, Duan N. Differences in HIV vaccine acceptability between genders. AIDS Care 2008; 20:542–546.
18. Lally M, Gaitanis M, Vallabhaneni S, Reinert S, Mayer K, Zimet G, et al. Willingness to receive an HIV vaccine among incarcerated persons. Prev Med 2006; 43:402–405.
19. Liau A, Zimet G, Fortenberry J. Attitudes about human immunodeficiency virus immunization: the influence of health beliefs and vaccine characteristics. Sex Transm Dis 1998; 25:76–81.
20. Liau A, Zimet G. Undergraduates' perception of HIV immunization: attitudes and behaviours as determining factors. Int J STD AIDS 2000; 11:445–450.
21. Liau A, Zimet G. The acceptability of HIV immunization: examining vaccine characteristics as determining factors. AIDS Care 2001; 13:643–650.
22. Mays R, Zimet G. Recommending STI vaccination to parents of adolescents: the attitudes of nurse practitioners. Sex Transm Dis 2004; 31:428–432.
23. Newman PA, Duan N, Cunningham WE, Rudy ET, Lee SJ, Seiden D. HIV vaccine acceptability among communities at risk: the impact of vaccine characteristics. Vaccine 2006; 24:2094–2101.
24. Newman PA, Roungprakhon S, Tepjan S, Yim S. Preventive HIV vaccine acceptability and behavioral risk compensation among high-risk men who have sex with men and transgenders in Thailand. Vaccine 2010; 28:958–964.
25. Ritvo P, Irvine J, Klar N, Wilson K, Brown L, Bremner K, et al. A Canadian national survey of attitudes and knowledge regarding preventive vaccines. J Immune Based Ther Vaccines 2003; 1:3.
26. Zimet G, Fortenberry JD, Blythe M, Dairaghi J, Schering S. Health beliefs and vaccine characteristics predict HIV vaccine acceptance among adolescent patients. J Adolesc Health 1996; 18:148.
27. Zimet G, Liau A, Fortenberry JD. Health beliefs and intention to get immunized for HIV. J Adolesc Health 1997; 20:354–359.
28. Zimet G, Fortenberry JD, Blythe MJ. Adolescents' attitudes about HIV immunization. J Pediatr Psychol 1999; 24:67–75.
29. Zimet G, Blythe MJ, Fortenberry JD. Vaccine characteristics and acceptability of HIV immunization among adolescents. Int J STD AIDS 2000; 11:143–149.
30. Zimet G, Perkins SM, Sturm LA, Bair RM, Juliar BE, Mays RM. Predictors of STI vaccine acceptability among parents and their adolescent children. J Adolesc Health 2005; 37:179–186.
31. Barrington C, Moreno L, Kerrigan D. Local understanding of an HIV vaccine and its relationship with HIV-related stigma. AIDS Care 2007; 19:871–877.
32. Barrington C, Moreno L, Kerrigan D. Perceived influence of an HIV vaccine on sexual-risk behavior in the Dominican Republic. Cult Health Sex 2008; 10:391–401.
33. Frew P, Crosby RA, Salazar LF, Gallinot LP, Bryant LO, Holtgrave DR. Acceptance of a potential HIV/AIDS vaccine among minority women. J Natl Med Assoc 2008; 100:802–813.
34. Griffin DK, Nyamathi A, Tallen L, Gonzalez-Figueroa E, Dominick E. Breaking the silence: what homeless 18- to 24- year-olds say about HIV vaccine trials. J Healthcare Poor Underserved 2007; 18:687–698.
35. Lee SJ, Brooks RA, Newman PA, Seiden D, Sangthong R, Duan N. HIV vaccine acceptability among immigrant Thai residents in Los Angeles: a mixed-method approach. AIDS Care 2008; 20:1161–1168.
36. Lindegger G, Quayle M, Ndlovu M. Local knowledge and experiences of vaccination: implications for HIV-preventive vaccine trials in South Africa. Health Educ Behav 2007; 34:108–123.
37. Mays RM, Sturm LA, Zimet GD. Parental perspectives on vaccinating children against sexually transmitted infections. Soc Sci Med 2004; 58:1405–1413.
38. Newman PA, Duan N, Rudy ET, Johnston-Roberts K. HIV risk and prevention in a postvaccine context. Vaccine 2004; 22:1954–1963.
39. Newman PA, Duan N, Rudy ET, Roberts KJ, Swendeman D. Posttrial HIV vaccine adoption: concerns, motivators, and intentions among persons at risk for HIV. J Acquir Immune Defic Syndr 2004; 3:1393–1403.
40. Newman PA, Seiden DS, Roberts KJ. A small dose of HIV? HIV vaccine mental models and risk communication. Health Educ Behav 2009; 36:321–333.
41. Nguyen F. Gauging the acceptability of HIV vaccines: an exploratory study examining knowledge, attitudes, and beliefs among injecting drug users in Viet Nam. J Ethnic Cultur Diversity Soc Work 2007; 16:161–192.
42. Nodin N, Carballo-Dieguez A, Ventuneac AM, Balan IC, Remien R. Knowledge and acceptability of alternative HIV prevention bio-medical products among MSM who bareback. AIDS Care 2008; 20:106–115.
43. Roberts KJ, Newman PA, Duan N, Rudy ET. HIV vaccine knowledge and beliefs among communities at elevated risk: conspiracies, questions and confusion. J Natl Med Assoc 2005; 97:1662–1671.
44. Rudy ET, Newman PA, Duan N, Kelly EM, Roberts KJ, Seiden DS. HIV vaccine acceptability among women at risk: perceived barriers and facilitators to future HIV vaccine uptake. AIDS Educ Prev 2005; 17:253–267.
45. Salazar LF, Holtgrave D, Crosby RA, Frew P, Peterson JL. Issues related to gay and bisexual men's acceptance of a future AIDS vaccine. Int J STD AIDS 2005; 16:546–548.
46. Sayles J, Macphail C, Newman PA, Cunningham W. Future HIV vaccine acceptability among young adults in South Africa.Health Educ Behav 2009. doi: 10.1177/1090198109335654.
47. Webb PM, Zimet GD, Fortenberry JD, Mays R. Having sex with anyone and everything: anticipated reactions to HIV immunization. J Adolesc Health 1997; 20:128.
48. Webb PM, Zimet GD, Mays R, Fortenberry JD. HIV immunization: acceptability and anticipated effects on sexual behavior among adolescents. J Adolesc Health 1999; 25:320–322.
49. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21:1539–1558.
50. Cohen J. A power primer. Psychol Bull 1992; 112:155–159.
51. Newman PA, Duan N, Rudy ET, Anton PA. Challenges for HIV vaccine dissemination and clinical trial recruitment: if we build it, will they come? AIDS Patient Care STDS 2004; 18:691–701.
52. Duan N. Listening to consumers and HIV vaccine preparedness. Lancet 2005; 365:1119–1121.
53. Mclean AR, Blower SM. Imperfect vaccines and herd immunity to HIV. Proc Biol Sci 1993; 253:9–13.
54. Blower SM, Bodine EN, Grovit-Ferbas K. Predicting the potential public health impact of disease-modifying HIV vaccines in South Africa: the problem of clades. Curr Drug Targets Infect Disord 2005; 5:179–192.
55. Streefland PH. Introduction of a HIV vaccine in developing countries: social and cultural dimensions. Vaccine 2003; 21:1304–1309.
56. Brooks R, Newman PA, Ortiz D, Duan N. HIV vaccine trial preparedness among Spanish-speaking Latinos in the United States. AIDS Care 2007; 19:52–58.
57. Elias C, Coggins C. Acceptability research on female-controlled barrier methods to prevent heterosexual transmission of HIV: Where have we been? Where are we going? J Womens Health Gend Based Med 2001; 10:163–173.
58. UNAIDS/WHO. Global facts and figures; 2009.

HIV vaccines; acceptability of healthcare; risks and benefits; efficacy; cost; health services accessibility; systematic review; meta-analysis

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