Determinants of personal demand for an AIDS vaccine in Uganda: contingent valuation survey.

OBJECTIVE To assess the factors affecting demand for an HIV/AIDS vaccine among adults in their prime earning and childbearing years and the impact of vaccination on risk behaviour in a high-prevalence, low-income country. METHODS A contingent valuation survey of 1677 adults aged 18-60 years was conducted in 12 districts in Uganda. Respondents were asked about a hypothetical vaccine to prevent HIV infection. Households were randomly assigned survey questionnaires with one of two levels of vaccine efficacy (50% or 95%) and one of five prices. The influence of demographic characteristics, vaccine efficacy, self-assessed risk of infection, price, and household assets on vaccine demand was assessed using multivariate regression analysis. FINDINGS Altogether, 94% (1576/1677) of respondents would be willing to be vaccinated with a free HIV/AIDS vaccine; 31% (78/251) would not be willing to be vaccinated at a price of 5000 Ugandan shillings (2.86 U.S. dollars). Household wealth, vaccine price, and risk behaviour were significant determinants of individual demand. Demand was equally high for both low-efficacy and high-efficacy vaccines. Respondents believed that condom use would be slightly less necessary with a high-efficacy vaccine (655/825; 79.4%) than a low-efficacy vaccine (690/843; 81.8%). However, reported condom use with partners other than spouses in the absence of a vaccine was much lower (137/271; 50.6%), with 26% (175/670) of men and 9.5% (96/1007) of women reporting having had partners other than their spouses during the past year. CONCLUSION The high demand for an AIDS vaccine of any level of efficacy can be explained by the heavy toll of AIDS in Uganda: 72% (990/1371) of respondents had lost a family member to the disease. An AIDS vaccine would be self-targeting: those with a greater chance of becoming infected and spreading HIV would be more likely to seek a vaccine, improving the efficiency of vaccination programmes. However,,high levels of risk behaviour in the population suggest that a low-efficacy vaccine alone would have only a limited impact on the epidemic.