20th International AIDS Conference - Melbourne, Australia


TUPE164 - Poster Exhibition

Mental models of placebo and vaccine-induced seropositivity among MSM in India: implications for interventions to counter preventive misconception among prospective HIV vaccine trial participants

V. Chakrapani1,2, P.A. Newman3, S. Mengle2, D. Shinde2, D.K. Dakshinamoorthy1, R. Nelson1, M. Shunmugam1,2

1Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, 2The Humsafar Trust, Mumbai, India, 3University of Toronto, Factor-Inwentash Faculty of Social Work/Centre for Applied Social Research, Toronto, Canada

Background: Understanding of key HIV vaccine trial concepts is important to ensuring informed decision-making about participation. In order to prepare for future trials among MSM in India, we explored how mental models (simplified cognitive representations of complex concepts) may influence understanding of trial concepts, with the purpose of informing educational interventions.
Methods: From October 2013 to January 2014 we conducted 40 in-depth interviews among a purposive sampling of diverse MSM from three community-based organizations in Chennai and Mumbai, and six key informant interviews with healthcare providers and community leaders. Interviews were audio-recorded, transcribed and translated into English. We used techniques of metaphor analysis and frame analysis to identify and explore mental models relevant to HIV vaccine trials, including placebo-control and vaccine-induced HIV seropositivity (VISP).
Results: Participants'' mean age was 28.1 years (SD=6.3); 65% (n=26) completed college and 80% (n=32) were employed, 20% (n=8) in sex work. Participants generally indicated understanding of vaccines; however, randomized controlled trials presented a variety of challenges. Participants largely understood “placebo,” providing several examples (“distilled water”, “fake product”); but the rationale behind randomized controlled trials was often misunderstood. For some, placebos were seen as an excuse for researchers in the event a test vaccine is not efficacious. Some described an imperative to unblind trial volunteers throughout, so appropriate ''precautions'' (e.g., condom use) can be taken. Participants with greater understanding referred to advertisements comparing two health drinks, detergents. VISP was largely misinterpreted as actual HIV infection: due to vaccine-induced infection, ''live'' HIV injection, and trial use of unsterile needles. Understanding of “false-positive” HIV tests facilitated accurate conceptions of VISP. A variety of misconceptions supported not practicing safer sex, including belief in test vaccine efficacy, “helping” researchers determine efficacy, and using VISP to surmise one was “protected.”
Conclusions: Some mental models, based on participants'' existing web of knowledge, facilitated understanding of key HIV vaccine trial concepts; but several others supported inaccuracies about trial rationales, risks, and fuelled preventive misconception. An evidence-informed mental models approach based on local understandings may complement traditional scientific literacy efforts to support HIV vaccine trial preparedness among MSM in India.

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