A qualitative examination of factors impacting Black and Latino sexual minority men's vaccination decision-making and experiences: application of the stages of vaccine readiness and action theoretical framework

Background Black and Latino sexual minority men (BLSMM) experience persistent inequities in vaccine uptake, driven by structural barriers, medical mistrust, misinformation, and limited culturally responsive communication. This study applied the Stages of Vaccine Readiness and Action (SVRA) framework to examine vaccine decision-making among BLSMM during infectious disease outbreaks in the United States. Methods We conducted a qualitative interpretative phenomenological study using semi-structured interviews with 41 BLSMM in California and New York between August 2021 and December 2022. Interviews explored vaccine experiences and barriers and facilitators to uptake. Data were analyzed using thematic content analysis guided by the SVRA framework. Results Participants ranged from 19 to 65 years; 73% identified as Black and 93% as male. Vaccine decision-making was dynamic and shaped by individual and structural factors across five SVRA stages: skepticism, curiosity, readiness, action, and maintenance. Skepticism reflected medical mistrust, misinformation, safety concerns, and distrust of governmental and scientific institutions. Curiosity centered on vaccine development, side effects, and conflicting information. Readiness and action were facilitated by trusted healthcare providers, protecting oneself and others, chronic health conditions, and community-based vaccination. Transportation, appointment systems, employment demands, and healthcare access impeded vaccination. Maintenance was undermined by vaccine fatigue, booster burden, side-effect concerns, and changing perceptions of vaccine effectiveness. Conclusion Vaccine decision-making among BLSMM occurs along a continuum shaped by psychosocial and structural determinants. Findings support culturally responsive education, trust-building, community-engaged interventions, and structural supports. Similar barriers may affect uptake and sustained engagement with long-acting injectable HIV prevention and treatment modalities.