Determinants of enrollment in a preventive HIV vaccine trial: hypothetical versus actual willingness and barriers to participation

OBJECTIVE: To compare hypothetical and actual willingness to enroll in a preventive HIV vaccine trial and identify factors affecting enrollment. METHODS: Participants previously enrolled in an HIV vaccine preparedness study (VPS) in 8 US cities were invited to be screened for a phase 2 HIV vaccine trial. Demographic and risk characteristics of those enrolling, ineligible, and refusing enrollment were compared using the chi2 or Fisher exact test. Multivariable logistic models were used to identify independent predictors of refusal. RESULTS: Of 2531 high-risk HIV-uninfected former VPS participants contacted for the vaccine trial, 13% enrolled, 34% were ineligible, and 53% refused enrollment. Only 20% of those stating hypothetical willingness during the VPS actually enrolled in this vaccine trial. In multivariate analysis, refusal was higher among African Americans and lower in persons >40 years of age, those attending college, and those with > or =5 partners in the prior 6 months. All racial ethnic groups cited concerns about vaccine-induced seropositivity; African Americans also cited mistrust of government and safety concerns as barriers to enrollment. CONCLUSIONS: Steps can be taken to minimize potential social harms and to mobilize diverse communities to enroll in trials. Statements of hypothetical willingness to participate in future trials may overestimate true enrollment.     

Posttrial HIV vaccine adoption: concerns, motivators, and intentions among persons at risk for HIV

BACKGROUND: Suboptimal uptake of existing vaccines, potential obstacles specific to HIV/AIDS stigma and mistrust, and marked health disparities suggest that it is vital to investigate consumer concerns, motivations, and adoption intentions regarding posttrial HIV vaccines before a vaccine is publicly available. METHOD: Nine focus groups were conducted with participants (n = 99; median age, 33 years; 48% female; 22% African American, 44% Latino, and 28% white) recruited from 7 high-risk venues in Los Angeles using purposive venue-based sampling. A semistructured interview guide elicited concerns, motivators, and adoption intentions regarding hypothetical U.S. Food and Drug Administration-approved HIV vaccines. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. RESULTS: Concerns included vaccine efficacy, vaccine-induced infection, vaccine-induced HIV seropositivity, side effects, cost/access, trustworthiness, and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partial efficacy vaccines and likelihood of increased sexual risk behaviors in response to vaccine availability. CONCLUSION: Tailored interventions to facilitate uptake of future U.S. Food and Drug Administration-approved HIV vaccines and to prevent risk behavior increases may be vital to the effectiveness of vaccines in controlling the AIDS pandemic.     

HIV vaccine knowledge and beliefs among communities at elevated risk: conspiracies, questions and confusion

HIV vaccines offer the best long-term hope of controlling the AIDS pandemic. We explored HIV vaccine knowledge and beliefs among communities at elevated risk for HIV/AIDS. Participants (N=99; median age=33 years; 48% female; 22% African-American; 44% Latino; 28% white; 6% other) were recruited from seven high-risk venues in Los Angeles, California, using purposive, venue-based sampling. Results from nine focus groups revealed: 1) mixed beliefs and conspiracy theories about the existence of HIV vaccines; 2) hopefulness and doubts about future HIV vaccine availability; 3) lack of information about HIV vaccines; and 4) confusion about vaccines and how they work. Tailored HIV vaccine education that addresses the current status of HIV vaccine development and key vaccine concepts is warranted among communities at risk. Ongoing dialogue among researchers, public health practitioners and communities at risk may provide a vital opportunity to dispel misinformation and rumors and to cultivate trust, which may facilitate HIV vaccine trial participation and uptake of future HIV vaccines.     

A qualitative investigation to inform yoga intervention recruitment practices for racial/ethnic minority adolescents in outpatient mental health treatment

ObjectiveYoga is recognized as an effective approach to improving overall physical and mental health; however, there may be perceived barriers to yoga participation, particularly among populations most at risk for mental health issues. We conducted qualitative formative research to help inform recruitment practices for a future study and to specifically understand the barriers and facilitators to engagement in yoga practice among racial/ethnic minority adolescents, as well as adolescents in outpatient mental health treatment.MethodsQualitative data were collected at a community health clinic that serves low income families in southeastern Florida. Using semi structured interviews with racial and ethnic minority adolescents between 12 and 17 years old, participants were asked about beliefs and perceptions about yoga, as well as recommendations on recruiting peers. A thematic analysis approach was used to identify and examine common themes.ResultsTwenty interviews were conducted and eight major themes emerged from the data. Themes were grouped as (1) Facilitators to recruitment and (2) Barriers to recruitment.InterpretationAdvertising free yoga that emphasizes the social, physical, and mental benefits can help assuage negative perceptions of yoga and promote the advantages of yoga among teenagers. Having recruitment materials and modalities that highlight inclusivity of all genders and physical abilities in the yoga classes are also important in facilitating participation. Understanding perceptions of yoga, as well as perceived barriers and facilitators, among racially/ethnically diverse adolescents in outpatient mental health treatment, can assist recruitment efforts, increase yoga intervention participation, and ultimately, improve mental health outcomes for underserved populations.     

Risk factors for missed HIV primary care visits among men who have sex with men

Benefits of anti-retroviral therapy (ART) depend on consistent HIV care attendance. However, appointment non-adherence (i.e. missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care. Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months, records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74, P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health, time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression and low appointment expectancy and self-efficacy may be targets to increase care engagement.     

Perceived disadvantages and concerns about abuses of genetic testing for cancer risk: differences across African American, Latina and Caucasian women

Participation in genetic testing for cancer risk is low among women of medically underserved ethnic groups and this is due, in part, to genetic testing attitudes, specifically perceived disadvantages of genetic testing and concerns about possible abuses of genetic testing. The goals of the current study were to: (a) explore genetic testing attitudes, and (b) determine the extent to which ethnicity, awareness of genetic testing, and medical mistrust are associated with genetic testing attitudes. African American, Latina, and Caucasian women (N=273) completed an interview assessing sociodemographic information, genetic testing awareness, medical mistrust, and genetic testing attitudes. Latina participants more strongly agreed with disadvantages of testing than the other ethnic groups. Both Latina and African American women more strongly concurred with concerns about testing abuses compared to Caucasian women. In hierarchical linear regression analyses, Spanish language preference and medical mistrust were the only significant predictors of perceived disadvantages and medical mistrust was the only significant predictor of abuse concerns. These findings support the importance of identifying genetic testing attitudes that may be culturally specific in order to promote culturally competent care by genetic risk professionals.     

Willingness of injection drug users to participate in an HIV vaccine efficacy trial in Bangkok, Thailand.

We assessed willingness to participate in an HIV recombinant gp120 bivalent subtypes B/E candidate vaccine efficacy trial among 193 injection drug users (IDUs) attending drug treatment clinics in Bangkok, Thailand. IDUs previously enrolled in a prospective cohort study were invited to group sessions describing a potential trial, then completed questionnaires assessing comprehension and willingness to participate. A week later, they completed a follow-up questionnaire that again assessed comprehension and willingness to participate, as well as barriers to and positive motives for participation, with whom (if anyone) they talked about the information, and whether others thought participation was a good, bad, or neutral idea. At baseline, 51% were definitely willing to participate, and at follow-up 54%; only 3% were not willing to participate at either time. Comprehension was high at baseline and improved at follow-up. Participants who viewed altruism, regular HIV tests, and family support for participation as important were more willing to volunteer. Frequency of incarceration and concerns about the length of the trial, possible vaccine-induced accelerated disease progression, and lack of family support were negatively associated with willingness. Overall, IDUs comprehended the information needed to make a fully informed decision about participating in an rgp120 vaccine efficacy trial and expressed a high level of willingness to participate in such a trial.     

Disclosure of HIV status: the role of ethnicity among people living with HIV in London

OBJECTIVE: To examine HIV disclosure among people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving medical care in National Health Service (NHS) clinics in northeast London completed a confidential, self-administered questionnaire. Respondents were asked whether they had told anyone else that they had HIV, and if so, whom. RESULTS: The analysis included 1407 people: 667 black African heterosexual respondents (453 women, 214 men) and 740 gay men (633 white, 107 ethnic minority). The majority of respondents (88.0%) had told at least 1 other person about their HIV infection, but this varied between groups: white gay men, 95.0%; ethnic minority gay men, 93.5%; black African heterosexual women, 84.8%; black African heterosexual men, 76.6% (P < 0.001). Black African heterosexual men (65.3%) and women (60.4%) were less likely to have told their current partner about their HIV infection than white (86.2%) or ethnic minority gay men (85.2%): black African men, adjusted odds ratio (AOR) 0.25, 95% confidence interval (CI) 0.14, 0.44, P < 0.001; black African women, AOR 0.24, 95% CI 0.15, 0.39, P < 0.001 (reference group, white gay men). Only 1 in 5 respondents (21.6%) had disclosed their HIV status to their employer (white gay men, 30.5%; ethnic minority gay men, 15.8%; black African heterosexual women, 10.5%; black African heterosexual men, 8.8%; P < 0.001). CONCLUSIONS: In this London study there were striking differences, by ethnicity, in the extent to which people with HIV disclosed their infection. This has important implications in light of the 2005 Disability Discrimination Act and recent prosecutions in the UK for the reckless transmission of HIV.     

The recruitment triangle: reasons why African Americans enroll, refuse to enroll, or voluntarily withdraw from a clinical trial. An interim report from the African-American Antiplatelet Stroke Prevention Study (AAASPS).

Recruitment and retention of study subjects are key to the success of a clinical trial. In the case of minority patients, this may be challenging as minority patients have been underserved by the medical health-care system. Furthermore, minority patients are more likely to experience barriers to entry into a clinical trial such as mistrust of the medical system, economic disadvantages, lack of awareness of study programs, and communication barriers. An open-ended questionnaire was used to determine reasons why subjects in the African-American Antiplatelet Stroke Prevention Study (AAASPS) remained in the study or voluntarily withdrew in the absence of an adverse event. Potential enrollees who refused to participate in the AAASPS also were queried. Enrollees who remained in the program consistently stated that they participated to reduce the risk of stroke recurrence and to help others by finding a "cure" for stroke. Those who withdrew or refused to participate consistently stated that they were afraid of being used as "guinea pigs." A "recruitment triangle" emerged that might predict a patient''s likelihood of participation in a clinical trial. The sides of the triangle include the patient, key family members and friends, and the primary medical doctor and other medical personnel. The organizers of a clinical trial need to be aware of the "recruitment triangle" and establish strategies to heighten and maintain its integrity.     

Minorities Remain Underrepresented in HIV/AIDS Research Despite Access to Clinical Trials

Background and Objective: The reasons for minority underrepresentation in HIV/AIDS clinical trials remain unclear. We aimed to evaluate the knowledge, experience, and factors that influence minority participation in HIV/AIDS studies in the United States. Methods: An anonymous, bilingual, self-administered survey on study participation was given to HIV-infected adults attending AIDS Clinical Trials Group–affiliated clinics in the United States and Puerto Rico. Chi-square tests were used to evaluate differences by race, first language, and level of education. Logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (CI) for factors associated with being talked to about participation in a study. Results: We analyzed 2,175 complete surveys (221 in Spanish). Among respondents, 31% were White, 40% were Black/African American (AA), and 21% were Hispanic. The overall rate of previous participation in any HIV/AIDS study was 48%. Hispanics were less likely to know about studies compared to Whites and AAs (67% vs 74% and 76%, respectively; P .001). Compared to Whites, AAs and Hispanics were less likely to have been talked to about participating in a study (76% vs 67% and 67%, respectively; P .001). The OR for being talked to about participating in a study was 0.65 (95% CI, 0.52–0.81) for AAs and 0.65 (95% CI, 0.49–0.85) for Hispanics, compared to Whites. AAs and Hispanics were more likely to state that studies were not friendly to their race (17% and 10% vs 4%; P .001). Conclusions: Minorities continue to face barriers for HIV/AIDS trial participation, even when clinical research is available. Enrollment strategies should better target minorities to improve recruitment in HIV/AIDS research.     

Acceptance of a potential HIV/AIDS vaccine among minority women

PURPOSE: To explore the attitudes, opinions and concerns of minority women regarding acceptance of a potential HIV/ AIDS vaccine. METHODS: In-depth interviews were conducted with high-risk minority women (> or =18 years of age) attending an urban Atlanta health clinic specializing in sexually transmitted diseases, including HIV/AIDS prevention and treatment. Interviews were transcribed and content analyzed to identify common factors related to acceptance of an HIV/AIDS vaccine. RESULTS: Nine major themes were identified. These were general acceptance of an HIV/AIDS vaccine, concerns about the vaccine, vaccine knowledge, testing and research, provider recommendation, mistrust, alternative medicine, misperceptions and vaccine accessibility/availability. A strong theme emerged about the need for information from HIV/AIDS vaccine clinical trials, including the demographics of the studies' volunteer base, to inform decision-making about taking an HIV/AIDS vaccine in the future. CONCLUSIONS: Although fewer than half of the women indicated they would receive or recommend the vaccine, most agreed that development of a vaccine was an important endeavor. The findings of this study may assist in future efforts to determine how best to promote acceptance of an HIV/AIDS vaccine to minority women should one become available.     

Enrollment of racial/ethnic minorities and women with HIV in clinical research studies of HIV medicines

PURPOSE: Inclusion of women and racial/ethnic minorities is a requirement for federally supported clinical research, but data on clinical research participation from women and racial/ethnic minorities with HIV are few. To describe participation in clinical research of HIV medicines among women and racial/ethnic minorities, and associated factors, we used data from a cross-sectional behavioral surveillance interview project conducted in 15 U.S. states. METHODS: Data were from 6,892 persons living with HIV infection, recruited in facilities in seven U.S. states and using population-based methods in eight other states, between 2000-2004. We calculated self-reported participation in a clinical research study of HIV medicines, factors associated with self-reported study participation among men and women, and reasons for not participating in a study among nonparticipants. MAIN FINDINGS: Overall, 17% of respondents had ever participated in a clinical research study. For men, the odds of participation were lower for black or Hispanic men (versus white men) and were higher for men whose risk for HIV infection was male-male sex (versus men with male-female sex risk) and for men with AIDS. For men who had not participated in a study, black men were more likely than white men to report not participating in a study because they were unaware of available studies or were not offered enrollment (75% vs. 69%), and because they did not want to be a "guinea pig" (11% vs. 8%). Among women, participation was not associated with race/ethnicity or risk for HIV infection but was associated with living in an area with an NIH- or CDC- supported clinical research network. HIV-infected women were more likely than HIV-infected men with comparable modes of HIV acquisition to have participated in a study. CONCLUSIONS: Among persons with HIV interviewed in these 15 states, self-reported participation in clinical research studies was higher among women than men, but racial/ethnic minority men were less likely to report study participation. Our data suggest that clinicians and researchers should make increased efforts to offer study participation to racial and ethnic minority men.     

Willingness to volunteer in future preventive HIV vaccine trials: issues and perspectives from three U.S. communities

This study examined perceived risks, benefits, and desired information related to willingness to volunteer in preventive HIV vaccine trials. SAMPLE: Purposive sampling was used to select 90 participants among injecting drug users (Philadelphia, PA, U.S.A.); gay men (San Francisco, CA, U.S.A.); and black Americans (Durham, NC, U.S.A.). METHODS: A qualitative interview guide elicited perceived benefits, risks, and desired information relating to trial participation. Themes were developed from the transcribed texts and from freelists. RESULTS: Stated willingness to volunteer in a preventive HIV vaccine trial was similar across the three communities. Eight perceived benefits were reported, including self-benefits, altruism, and stopping the spread of AIDS. Seven perceived risks were reported, including negative side effects and vaccine safety issues, contracting HIV from the vaccine, and social stigmatization. Participants voiced the desire for eight types of information about issues relating to trust and confidentiality in the research process, health complications and later assistance, and vaccine trial methodology. CONCLUSIONS: In this study, many benefits as well as risks of preventive HIV vaccine trial participation were cited. Scientists conducting preventive HIV vaccine trials need to address community perceptions of risks and provide information about the research if trial enrollment is to be diverse and successful.     

Recruitment and baseline epidemiologic profile of participants in the first phase 3 HIV vaccine efficacy trial

OBJECTIVE: To describe recruitment and baseline epidemiologic characteristics of volunteers in the first phase 3 placebo-controlled trial of a recombinant gp120 HIV vaccine (AIDSVAX B/B). METHODS: Volunteers were gay/bisexual men or women at risk for sexually transmitted HIV infection. Recruitment strategies, demographics, and risk factors were assessed. HIV status was determined by standard HIV-1 antibody assays. Seronegative/viremic HIV infection at enrollment was determined using the HIV-1 nucleic acid test. RESULTS: From June 1998 through October 1999, 5417 of 7185 volunteers screened were enrolled at 61 sites in the United States, Canada, and The Netherlands. Successful recruitment methods included distribution of study information at gay venues, advertising and media coverage, and referrals from volunteers. Most volunteers were altruistically motivated, men (98%), young (median, 36 years), white (83%), well educated (61% college education or more), and at high risk for HIV during the 6 months before enrollment. At baseline, 14 were HIV infected (12 were seronegative but viremic; 2 were seropositive and viremic). CONCLUSION: Men and women at high risk for sexually transmitted HIV infection were successfully recruited for the first phase 3 HIV vaccine efficacy trial. Knowledge of recruitment and baseline epidemiologic characteristics of participants in this trial will provide valuable guidance for designing and conducting future trials.     

Motivations for participating in an HIV vaccine efficacy trial

Understanding why people join HIV vaccine efficacy trials is critical for trial recruitment and education efforts. We assessed participants' motivations for joining the VaxGen VAX004 study, a randomized, double-blind, placebo-controlled, phase 3 multicenter trial. Of 5417 participants, 94% were men who have sex with men (MSM) and 6% were women at risk for heterosexual transmission of HIV. Most participants gave altruistic reasons for trial participation: 99% reported having joined to help find an HIV vaccine, and 98% reported having joined to help their community. Some gave more personal reasons: 56% joined to reduce risk behavior and 46% joined to get protection from HIV. Additional reasons related to receiving services or compensation included to obtain information about HIV (75%), to receive free HIV testing (34%), and for financial reimbursement (14%). Multivariate logistic regression analysis showed that female participants were significantly more motivated than male participants to join the trial for protection and to receive services or compensation (all P<0.05). Participants with 13 or more sex partners in the 6 months before enrollment were more likely than those with fewer sex partners to report having joined the trial for protection but less likely to have joined to reduce risk behavior (both P<0.05). Because many participants reported personal protection from HIV as their reason for joining, vaccine trial risk-reduction counseling should continue to emphasize the placebo-controlled trial design and unknown efficacy of the test product, particularly for women and persons with large numbers of sex partners. Because a significant minority of participants reported joining to receive HIV information, HIV testing, and financial reimbursement, a need is indicated for provision of HIV prevention services outside research trials and for monitoring to ensure that participants are not motivated to join trials for financial gain.     

Assessing the attitudes, knowledge, and awareness of HIV vaccine research among adults in the United States

OBJECTIVES: To assess HIV vaccine research attitudes, awareness, and knowledge among adults in the general US population, African Americans, Hispanics, and men who have sex with men (MSM). METHODS: Applying results of focus groups and a media content analysis, a survey was designed and conducted to validate key HIV vaccine research themes and messages identified by focus groups and a media content analysis. Between December 2002 and February 2003, 3509 telephone interviews were conducted, including 2008 randomly selected from the general population, and 501 population-specific samples of African Americans and Hispanics, and 500 from MSM. RESULTS: Although the majority of each population believes that an HIV preventive vaccine is the best way to control and end the global AIDS epidemic, only 34.9% of African Americans and 28.8% of the general population are supportive of someone they know volunteering for an HIV vaccine trial. The study also found that 47.1% of African Americans, 26.5% of Hispanics, and 13.4% of MSM believed an HIV vaccine already exists and is being kept secret, and 78.0% of African Americans, 57.5% of Hispanics, and 68.0% of MSM did not know or incorrectly believed that the vaccines being tested could cause HIV infection. A subanalysis of the general population also found that women generally had less knowledge of or a decreased awareness about HIV vaccine research. CONCLUSIONS: Awareness, knowledge, and attitudes toward HIV vaccine research vary by population and these issues must be addressed to ensure an adequate number of volunteers for future domestic HIV preventive vaccine clinical trials. In some populations, barriers such as misinformation and distrust must be targeted to increase support for HIV vaccine research.     

Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men

Discrimination has been found to have deleterious effects on physical health. The goal of the present study was to examine the association between perceived discrimination and adherence to antiretroviral therapy (ART) among HIV-positive Latino men and the extent to which medical mistrust serves as a mediator of that association. A series of linear and logistic regression models was used to test for mediation for three types of perceived discrimination (related to being Latino, being perceived as gay and being HIV-positive). Medical mistrust was found to be significantly associated with perceived discrimination based on Latino ethnicity and HIV serostatus. Medical mistrust was found to mediate the associations between two types of perceived discrimination (related to being Latino and being HIV-positive) and ART adherence. Given these findings, interventions should be developed that increase the skills of HIV-positive Latino men to address both perceived discrimination and medical mistrust.     

Partner-specific sexual behavioral differences between phase 3 HIV vaccine efficacy trial participants and controls: Project VISION

OBJECTIVE: To assess and compare sexual behaviors using partner-specific data between HIV-negative men who have sex with men (MSM) recruited for an HIV vaccine efficacy trial and a control group. METHODS: HIV-negative MSM from an HIV vaccine trial (n = 525) and controls (n = 732) were recruited by similar strategies and interviewed about behaviors with the 3 most recent partners in the past 6 months, obtained by audio computer-assisted self-interview (A-CASI). RESULTS: Vaccine trial participants were more likely than controls to report an HIV-positive partner (24.7% and 14.1%, respectively) or an HIV-positive primary partner (16.1% and 6.8%, respectively) and were less likely to report occasional or single-time partners of unknown HIV status (51.6% and 63.2%, respectively; P < 0.05 for each comparison). Vaccine trial participants more often reported receptive unprotected anal intercourse (UAI) during their last sexual encounter with an HIV-positive partner (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.0 to 7.9). Most believed their HIV-positive partners were receiving antiretroviral treatment (ART), however, and after adjustment for perceived ART use, the association between vaccine study participation and receptive UAI with an HIV-positive partner was not significant. CONCLUSIONS: High-risk sexual behavior was reported by many VAX004 participants and controls. Differences between vaccine trial and control participants in the highest risk per contact behavior, receptive UAI with HIV-positive partners, was partly accounted for by perceived ART use. Partner level data are useful in refining risk assessment, which is important in the evaluation of HIV vaccine and other prevention trials.     

Conspiracy beliefs about the origin of HIV/AIDS in four racial/ethnic groups

We examined beliefs about the origin of HIV as a genocidal conspiracy in men and women of four racial/ethnic groups in a street intercept sample in Houston, Texas. Groups sampled were African American, Latino, non-Hispanic white, and Asian. Highest levels of conspiracy theories were found in women, and in African American and Latino populations (over a quarter of African Americans and over a fifth of Latinos) with slightly lower rates in whites (a fifth) and Asians (less than one in ten). Reductions in condom use associated with such beliefs were however only apparent in African American men. Conspiracy beliefs were an independent predictor of reported condom use along with race/ethnicity, gender, education, and age group. Data suggest that genocidal conspiracy beliefs are relatively widespread in several racial/ethnic groups and that an understanding of the sources of these beliefs is important to determine their possible impact on HIV prevention and treatment behaviors.