“I Didn’t Believe It Was Real”: A Qualitative Exploration of COVID-19 Vaccine Hesitancy among Community Key Populations Living with HIV/AIDS in Rivers State, Nigeria

Background COVID-19 vaccination remains one of the most effective interventions against the pandemic; however, hesitancy continues to impede equitable coverage, particularly among community key populations. In Nigeria, MSM, FSW, and PWID face heightened vulnerability to both HIV/AIDS and COVID-19, but remain underrepresented in vaccination research. This study explored COVID-19 vaccine hesitancy among these community key populations living with HIV/AIDS in Rivers State, Nigeria. Methods A 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), across MSM, FSW, and PWID receiving ART at selected OSS treatment centres. 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. Results Five 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 reported misinformation, political distrust, and discrimination at health facilities as major deterrents. Conclusions COVID-19 vaccine hesitancy among community key populations in Rivers State is driven 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.