COVID-19 Vaccination Refusal and Non-Uptake Among People Living with HIV in the United States

More than a million individuals in the United States are living with HIV and constitute a particularly vulnerable group for morbidity and mortality associated with COVID-19. Despite the early availability and prioritization of this group for COVID-19 vaccination, notable levels of vaccine refusal and non-uptake have been reported among this group. This scoping review aimed to investigate the nature and extent of COVID-19 vaccine refusal and non-uptake among people living with HIV (PLWH) in the USA. A comprehensive literature search was performed utilizing multiple scholarly databases for studies published between December 2020 and May 2026 that reported on COVID-19 vaccine refusal or non-uptake rates among PLWH in the USA. Data extraction focused on sample size, refusal/non-uptake rates, reasons for refusal, and vaccination enablers. A total of 27 studies were included, encompassing 185,430 PLWH from various settings across the U.S. and the COVID-19 vaccination refusal and non-uptake rates varied from 3.8% to 57.9% [average across all studies=21.0% (95% CI=16.2-26.2%)]. Major barriers identified included medical mistrust, apprehensions regarding vaccine safety and side effects, misinformation, structural issues such as poverty and housing instability, and sociodemographic factors (e.g., sexual/ethnic minority status, lower income or education). Conversely, enablers of vaccination included older age, male gender, White race, active engagement in HIV care, previous vaccination history, recommendations from trusted providers, and higher perceived infection risk or belief in vaccination. The refusal and non-uptake rates for COVID-19 vaccines among PLWH in the USA are considerable and influenced by multiple factors. Interventions should focus on addressing systemic mistrust and psychosocial or structural obstacles while utilizing the existing HIV care framework to increase vaccination rates in this population.