Inoculating and boosting against HIV vaccine misinformation among adolescent girls and young women in South Africa

PROJECT SUMMARY A safe, effective, affordable and acceptable vaccine against HIV has been an epidemic-ending goal for decades, and recent years have seen substantial progress towards developing and testing promising candidate vaccines. For highly vulnerable groups like adolescent girls and young women (AGYW) in sub-Saharan Africa, access and uptake of vaccines will be essential for reducing the exceptionally high HIV incidence observed in recent years. This is particularly true in South Africa, which has the world's largest HIV epidemic and several active HIV vaccine trial programs. While an HIV vaccine has the potential to substantially reduce HIV risk, realizing this potential will require widespread vaccine uptake. Unfortunately, the lived experiences of both the HIV epidemic and the ongoing COVID-19 pandemic have laid the groundwork for an infodemic of misinformation about the HIV vaccine. Likely attributes of the HIV vaccine (e.g., partial protection against HIV), low trust in governmental and medical research institutions, and poor understanding of how vaccines work will leave an HIV vaccine program vulnerable to misinformation among the populations who would most benefit from vaccine-induced protection. To realize the benefits of future HIV vaccines, novel communication strategies are needed to "inoculate" individuals at highest risk of HIV infection against contagious vaccine misinformation. In this study, we bring together two promising approaches - psychological inoculation theory and behavioral economics - to fight HIV vaccine misinformation. Psychological inoculation theory offers a compelling approach to building "resistance" to vaccine misinformation through explicit exposure to a "weakened" version (via direct refutation) of false arguments underlying misinformation, before stronger versions of misinformation are encountered. Importantly, by posits debunking prebunking (or pre-emptively warning individuals about) emerging misinformation, inoculation theory also that t hey will be better able to r esist future misinformation. Prebunking avoids the greater challenge of once misinformation has lodged. In addition, behavioral economics provides a complementary framework that recognize the cognitive and attentional constraints faced by individuals and can inform more effective inoculation messages. We propose a randomized controlled trial of inoculation messages with a behavioral economics "boost" with AGYW in South Africa, a population highly vulnerable to both HIV infection and to vaccine misinformation. Mirroring a vaccine trial, our behavioral trial will evaluate the efficacy, safety, durability, and generalized immunity effects of inoculation messages that are boosted with behavioral economics insights. We will also evaluate differential responses to the messages by important subgroups of AGYW. This proof--of-concept project has the potential to identify innovative communication strategies to build resistance to emerging and evolving HIV vaccine misinformation. Results from the study will advance the science of HIV vaccine demand creation and inoculation-theory based approaches to vaccine communication.