COVID-19 vaccine uptake and hesitancy among HIV-infected men who have sex with men in mainland China: a cross-sectional survey

Figures & data

Table 1. Demographics, mental health status and HIV characteristics among HIV-infected MSM in China, stratified by degree of vaccine hesitancy

Variables	Total (N = 1182) n (%)	Lower vaccine hesitancy (N = 624) n (%)	Higher vaccine hesitancy (N = 558) n (%)	P
Age, year				0.036
≤25	333 (28.2)	192 (30.8)	141 (25.3)
26–44	800 (67.7)	402 (64.4)	398 (71.3)
≥45	49 (4.1)	30 (4.8)	19 (3.4)
Gender				0.491
Cisgender men	1060 (89.7)	556 (89.1)	504 (90.3)
Transgender women	122 (10.3)	68 (10.9)	54 (9.7)
Sexual orientation				0.173
Heterosexual	19 (1.6)	13 (2.1)	6 (1.1)
Homosexual	910 (77.0)	487 (78.0)	423 (75.8)
Other or not sure^a	253 (21.4)	124 (19.9)	129 (23.1)
Residency^b				0.606
Local residency	538 (45.9)	280 (45.2)	258 (46.7)
None local residency	633 (54.1)	339 (54.8)	294 (53.3)
Marital status				0.776
Single	695 (58.8)	358 (57.4)	337 (60.4)
Spouse	114 (9.6)	62 (9.9)	52 (9.3)
Boyfriend or male partner	284 (24.0)	154 (24.7)	130 (23.3)
Girlfriend or female partner	26 (2.2)	13 (2.1)	13 (2.3)
Divorce/separation/widower	63 (5.3)	37 (5.9)	26 (4.7)
Education				0.691
High school or below	279 (23.6)	143 (22.9)	136 (24.4)
Bachelor or college	794 (67.2)	426 (68.3)	368 (65.9)
Master or doctor	109 (9.2)	55 (8.8)	54 (9.7)
Occupation^c				0.357
Full-time job	660 (57.7)	362 (59.8)	298 (55.4)
Farmers	25 (2.2)	15 (2.5)	10 (1.9)
Students	113 (9.9)	63 (10.4)	50 (9.3)
Freelancers	203 (17.8)	96 (15.9)	107 (19.9)
Self-employed	51 (4.5)	25 (4.1)	26 (4.8)
Unemployed or retired	91 (8.0)	44 (7.3)	47 (8.7)
Income (RMB)				0.443
0–1999	232 (19.6)	113 (18.1)	119 (21.3)
2000–4999	475 (40.2)	261 (41.8)	214 (38.4)
5000–9999	347 (29.4)	185 (29.6)	162 (29.0)
≥10000	128 (10.8)	65 (10.4)	63 (11.3)
Types of health insurance^d
Social health insurance	1024 (90.1)	543 (90.5)	481 (89.7)	0.667
Business health insurance	90 (7.9)	50 (8.3)	40 (7.5)	0.588
Other	85 (7.5)	43 (7.2)	42 (7.8)	0.669
Experience of disability				0.077
Yes	542 (45.9)	271 (43.4)	271 (48.6)
No	640 (54.1)	353 (56.6)	287 (51.4)
Experience of chronic diseases				0.306
Yes	406 (34.3)	206 (33.0)	200 (35.8)
No	776 (65.7)	418 (67.0)	358 (64.2)
Frailty status				0.202
Robust	440 (37.2)	239 (38.3)	201 (36.0)
Prefrail	724 (61.3)	379 (60.7)	345 (61.8)
Frail	18 (1.5)	6 (1.0)	12 (2.2)
Level of depression severity, PHQ-9 score				0.029
Minimal (scores 0–4)	352 (29.8)	211 (33.8)	141 (25.3)
Mild (scores 5–9)	343 (29.0)	175 (28.0)	168 (30.1)
Moderate (scores 10–14)	229 (19.4)	111 (17.8)	118 (21.1)
Moderately severe (scores 15–19)	125 (10.6)	60 (9.6)	65 (11.6)
Severe (scores 20–27)	133 (11.3)	67 (10.7)	66 (11.8)
Level of anxiety severity, GAD-7 score				0.046
Minimal (scores 0–4)	502 (42.5)	287 (46.0)	215 (38.5)
Mild (scores 5–9)	354 (29.9)	169 (27.1)	185 (33.2)
Moderate (scores 10–14)	164 (13.9)	82 (13.1)	82 (14.7)
Severe (scores 15–21)	162 (13.7)	86 (13.8)	76 (13.6)
Viral load of HIV in recent year				0.500
Detectable	133 (11.3)	65 (10.4)	68 (12.2)
Undetectable	903 (76.4)	485 (77.7)	418 (74.9)
Not sure	146 (12.4)	74 (11.9)	72 (12.9)
HIV transmission route				0.014
Male-male sex	1050 (88.8)	570 (91.3)	480 (86.0)
Other	36 (3.0)	14 (2.2)	22 (3.9)
Not sure	96 (8.1)	40 (6.4)	56 (10.0)
Time since HIV diagnosis^e				0.735
<6 months	64 (5.4)	31 (5.0)	33 (5.9)
6–12 months	63 (5.3)	31 (5.0)	32 (5.7)
13–35 months	453 (38.4)	246 (39.5)	207 (37.1)
≥36 months	600 (50.8)	314 (50.5)	286 (51.3)
ART adherence, MMAS-8 score				0.002
Low (scores < 6)	221 (18.7)	103 (16.5)	118 (21.1)
Medium (6 ≤ scores < 8)	595 (50.3)	301 (48.2)	294 (52.7)
High (scores = 8)	366 (31.0)	220 (35.3)	146 (26.2)

Degree of vaccine hesitancy was dichotomized into “lower” and “higher” by the median value of scores of the Vaccine Hesitancy Scale (VHS). USD 1 ≈ RMB 6.4. The bold values are statistically significant (P<.05) in Chi-squared tests. MSM, men who have sex with men; ART, antiretroviral therapy.

^aOptions in sexual orientation of “bisexual,” “pansexual” and “not sure” were recategorized into “other and not sure.”

^b11 missing.

^c39 missing.

^dThis was a multiple choice question and we deleted 46 logically contradicted answers (there are four types of social medical insurances in China and one citizen can only have reimbursement through one, if participants chose multiple then the answer was regarded invalid).

^eDeleted 2 logically contradictory answers.

Table 2. Knowledge of and attitudes toward COVID-19 pandemic and COVID-19 vaccine among HIV-infected MSM in China, stratified by degree of vaccine hesitancy

Variables	Total (N = 1182) n (%)	Lower vaccine hesitancy (N = 624) n (%)	Higher vaccine hesitancy (N = 558) n (%)	P
Perception of the severity of SARS-CoV-2				<0.001
Severe	596 (50.4)	340 (54.5)	256 (45.9)
Moderate	456 (38.6)	236 (37.8)	220 (39.4)
Mild	68 (5.8)	22 (3.5)	46 (8.2)
No idea	62 (5.2)	26 (4.2)	36 (6.5)
Frequency of following information about the COVID-19 vaccine				<0.001
Often	381 (32.2)	253 (40.5)	128 (22.9)
Sometimes	594 (50.3)	300 (48.1)	294 (52.7)
Seldom or never^a	207 (17.5)	71 (11.4)	136 (24.4)
Source of COVID-19 information^b
Internet	1094 (96.1)	592 (96.6)	502 (95.6)	0.405
TV programs	451 (39.6)	255 (41.6)	196 (37.3)	0.143
Communication with friends and family	167 (14.7)	85 (13.9)	82 (15.6)	0.405
Expert lectures	127 (11.2)	82 (13.4)	45 (8.6)	0.010
Other	3 (0.3)	2 (0.3)	1 (0.2)	1.000*
Vaccine preference				<0.001
Domestic vaccines	1044 (88.3)	584 (93.6)	460 (82.4)
Imported vaccines	138 (11.7)	40 (6.4)	98 (17.6)
Can ART prevent COVID-19				0.007
Yes	211 (17.9)	112 (17.9)	99 (17.7)
No	424 (35.9)	248 (39.7)	176 (31.5)
Not sure	547 (46.3)	264 (42.3)	283 (50.7)
COVID-19 impact on clinical attendance or ART collection				0.098
Moderately severe or severe	672 (56.9)	373 (59.8)	299 (53.6)
Moderate	287 (24.3)	140 (22.4)	147 (26.3)
Mild or none	223 (18.9)	111 (17.8)	112 (20.1)
COVID-19 impact on immunity				0.023
Moderately severe or severe	685 (58.0)	372 (59.6)	313 (56.1)
Moderate	265 (22.4)	148 (23.7)	117 (21.0)
Mild or none	232 (19.6)	104 (16.7)	128 (22.9)
COVID-19 impact on discrimination and inequity				0.480
Moderately severe or severe	690 (58.4)	359 (57.5)	331 (59.3)
Moderate	265 (22.4)	137 (22.0)	128 (22.9)
Mild or none	227 (19.2)	128 (20.5)	99 (17.7)
COVID-19 impact on other psychologic disruptions				0.124
Moderately severe or severe	623 (52.7)	329 (52.7)	294 (52.7)
Moderate	290 (24.5)	141 (22.6)	149 (26.7)
Mild or none	269 (22.8)	154 (24.7)	115 (20.6)
Reasons not to initiate the COVID-19 vaccination^c
Concern about personal financial situation	99 (8.4)	44 (7.1)	55 (9.9)	0.082
Concern about the efficacy	205 (17.3)	60 (9.6)	145 (26.0)	<0.001
Concern about side effects	549 (46.4)	204 (32.7)	345 (61.8)	<0.001
Concern about disclosure of HIV infection	456 (38.6)	202 (32.4)	254 (45.5)	<0.001
Waiting for vaccination programs organized at workplace^d	384 (36.0)	246 (44.6)	138 (26.7)	<0.001
Unawareness of where to get COVID-19 vaccine	387 (32.7)	245 (39.3)	142 (25.4)	<0.001
Regarded vaccination as unnecessary	21 (1.8)	9 (1.4)	12 (2.2)	0.357
Doctors told me not to take COVID-19 vaccines	15 (1.3)	8 (1.3)	7 (1.3)	0.966
Other	29 (2.5)	16 (2.6)	13 (2.3)	0.795

Degree of vaccine hesitancy was dichotomized into “lower” and “higher” by the median value of scores of the Vaccine Hesitancy Scale (VHS). The bold values are statistically significant (P<.05) in Chi-squared tests. “*” was used if P value was calculated by continuity correction. MSM, men who have sex with men; ART, antiretroviral therapy.

^aOptions in attention frequency of “seldom” and “never” were integrated into “seldom and never.”

^bThis was a multiple choice question and 44 participants chose “never pay attention to progress of recent COVID-19 vaccine research” so they did not need to answer this question.

^cA multiple choice question.

^dDeleted 114 logically contradicted answers.

Figure 1. Reasons to initiate (A) and not to initiate (B) COVID-19 vaccination among HIV-infected MSM in China.

MSM: Men who have sex with men.

Figure 2. View on each item of the Vaccine Hesitancy Scale among HIV-infected MSM in China (N = 1182).

MSM: Men who have sex with men. The Scale was revised from the ten-item Vaccine Hesitancy Scale developed by the WHO Strategic Advisory Group on Experts (SAGE) Working Group. Scores of each item are 1 = Strongly disagree, 2 = Disagree, 3 = Neither agree nor disagree, 4 = Agree, 5 = Strongly agree. Item 2,3,6,7 were wording reversing to ensure the reliability of the scale. However, scores of the rest items were flipped so that emotional direction of all items can be the same. Higher total scores reflected more hesitant attitude toward the COVID-19 vaccine.

Table 3. Correlates of COVID-19 vaccine hesitancy among HIV-infected MSM in China

Variables	aOR (95% CI)	P
Age, year
≤25	0.71 (0.34–1.47)	0.359
26–44	0.91 (0.45–1.84)	0.799
≥45	Ref
Level of depression severity, PHQ-9 score
Minimal (scores 0–4)	Ref
Mild (scores 5–9)	0.99 (0.66–1.47)	0.947
Moderate (scores 10–14)	1.29 (0.78–2.13)	0.321
Moderately severe (scores 15–19)	1.19 (0.62–2.29)	0.597
Severe (scores 20–27)	1.07 (0.50–2.31)	0.854
Level of anxiety severity, GAD-7 score
Minimal (scores 0–4)	Ref
Mild (scores 5–9)	1.25 (0.85–1.85)	0.264
Moderate (scores 10–14)	1.02 (0.59–1.78)	0.944
Severe (scores 15–21)	0.90 (0.44–1.81)	0.760
HIV transmission route
Male-male sex	Ref
Other	2.10 (0.93–4.73)	0.072
Not sure	1.39 (0.83–2.33)	0.210
ART adherence, MMAS-8 score
Low (scores < 6)	Ref
Medium (6 ≤ scores < 8)	0.91 (0.63–1.33)	0.635
High (scores = 8)	0.53 (0.35–0.80)	0.003
Perception of the severity of SARS-CoV-2
Severe	0.65 (0.34–1.24)	0.192
Moderate	0.78 (0.41–1.49)	0.451
Mild	1.56 (0.66–3.65)	0.311
No idea	Ref
Frequency of following information about the COVID-19 vaccine
Often	0.26 (0.17–0.40)	<0.001
Sometimes	0.46 (0.31–0.67)	<0.001
Seldom or never	Ref
Vaccine preference
Domestic vaccines	0.37 (0.24–0.59)	<0.001
Imported vaccines	Ref
Can ART prevent COVID-19
Yes	Ref
No	0.97 (0.65–1.45)	0.891
Not sure	1.37 (0.93–2.00)	0.110
COVID-19 impact on immunity
Moderately severe or severe	0.54 (0.38–0.78)	0.001
Moderate	0.58 (0.38–0.90)	0.014
Mild or none	Ref
Reasons not to initiate the COVID-19 vaccination
Concern about the efficacy
Yes	1.72 (1.16–2.54)	0.007
No	Ref
Concern about side effects
Yes	2.44 (1.78–3.35)	<0.001
No	Ref
Concern about disclosure of HIV infection
Yes	1.06 (0.78–1.43)	0.707
No	Ref
Waiting for vaccination programs organized at workplace
Yes	0.60 (0.44–0.81)	0.001
No	Ref
Did not know where to where to get COVID-19 vaccine
Yes	0.61 (0.45–0.82)	0.001
No	Ref

The bold values are statistically significant (P < .05). aOR, adjusted odds ratio; CI, confidence interval; MSM, men who have sex with men; ART, antiretroviral therapy.