ArticleBMC public health2026
"I didn't believe it was real": a qualitative exploration of COVID-19 vaccine hesitancy among key populations living with HIV/AIDS in Rivers State, Nigeria.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCOVID-19 vaccination remains one of the most effective interventions against the pandemic; however, hesitancy continues to impede equitable coverage, particularly among key populations. In Nigeria, MSM, FSW, and PWID face heightened vulnerability to both HIV/AIDS and COVID-19, but remain underrepresented in vaccination research. Rivers State reported one of the highest numbers of confirmed cases and deaths in the southern region. The state also has a relatively high HIV prevalence rate and houses several key population OSSs. This study explored COVID-19 vaccine hesitancy among these key populations living with HIV/AIDS in Rivers State, Nigeria.
methodsA qualitative descriptive design was employed using FGDs with MSM, FSW, and PWID receiving ART at selected HIV treatment OSSs. A total of 8 FGDs were conducted, each involving 5-7 participants (48 participants in total). Data collection continued until thematic saturation was achieved. Discussions were audio-recorded, transcribed verbatim, and analysed inductively using systematic text condensation in NVivo 12. We developed themes iteratively to capture participants' experiences and interpretations of COVID-19 vaccination.
resultsFive interrelated themes emerged: (1) limited and contradictory knowledge about COVID-19 and its vaccines; (2) disbelief and low perceived susceptibility summed up by the recurring phrase "I didn't believe it was real"; (3) fear of side effects and uncertainty regarding vaccine-ART interactions; (4) structural, socio-economic, and stigma-related barriers reinforcing mistrust; and (5) trust, peer influence, and integration of services as facilitators of acceptance. Participants described misinformation, political distrust, and discrimination at health facilities as major deterrents.
conclusionsCOVID-19 vaccine hesitancy among key populations in Rivers State was shaped by disbelief, fear, and structural exclusion rather than outright refusal. Interventions that integrate vaccination within key population HIV/AIDS services, leverage peer networks, provide clear ART-compatible health information, and promote stigma-free healthcare environments can effectively build confidence and increase vaccine uptake among marginalized groups.
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