February 25, 2016
Despite U.S. guidelines recommending HPV vaccination for all adolescents and young adults, only 7% of young gay or bisexual men in a U.S. national sample had received one or more doses of the HPV vaccine.1 The young men surveyed found HPV vaccination highly acceptable, but only 4% of their clinicians offered HPV vaccination to men not already vaccinated.
Human papillomavirus (HPV) passes from person to person during sex more often than any other sexually transmitted infection in the United States.2 Because three doses of an HPV vaccine can protect people from HPV, U.S. health authorities recommend HPV vaccination for all boys and girls starting at age 11, up through age 21 for young men, and up through age 26 for young women.2 They recommend the vaccine for young gay or bisexual men and for young men with HIV up to age 26. Avoiding HPV infection is important because it can cause anal cancer in men and women, cervical cancer in women, other cancers in men and women, and genital warts.
Gay or bisexual men run a particularly high risk of HPV infection and HPV-related cancers. Experts estimate that 4.6 million men in the United States get infected with HPV every year.3 Anal HPV affects about 60% of HIV-negative gay or bisexual men and 95% of HIV-positive gay or bisexual men.
To get a better understanding of HPV vaccination rates and barriers to vaccination in young gay or bisexual men, researchers from Indiana University and other institutions conducted this study.
This December 2011 study involved 18- to 26-year-old gay or bisexual men who lived in the United States and registered to use a Web site for men looking for social or sexual contact with other men. The analysis focused on men who provided complete information about HPV vaccination history and beliefs about HPV infection and vaccination.
The researchers used standard statistical methods to determine acceptability of free HPV vaccination among survey respondents not already vaccinated. This analysis considered factors like health care use, beliefs about HPV infection, and knowledge about HPV infection and vaccination. The research team performed a separate statistical analysis considering health care use, HPV knowledge, age, and race to determine factors linked to actually getting the HPV vaccine.
The researchers focused on 1457 men averaging 22.5 years in age, 76% of them white, 10% Hispanic, 5% black, 4% Asian or Pacific Islander, and the rest another race or ethnicity. Almost all men, 94%, had sex with another person in the last year, and 81% had sex with more than 1 person in the last year (Figure 1). Among men who had receptive anal sex (being the bottom), only 26% used a condom every time the last 10 times. Most men, 86%, had seen a healthcare provider in the last year, and 82% had some type of insurance, but only 37.5% told their provider they were gay or bisexual.
Figure 1. High proportions of young gay or bisexual men had more than 1 sex partner in the past year, saw their healthcare provider in the past year, knew about the HPV vaccine, and got tested for a sexually transmitted disease (STD) in the past year. But only 26% always used a condom during receptive anal sex, only 7% got the HPV vaccine, and only 4% of unvaccinated men got offered the HPV vaccine by their provider. (HPV photo from Laboratory of Tumor Virus Biology, National Cancer Institute Visuals Online.)
A large majority of survey respondents, 88%, had heard of HPV, and 74% had heard of the HPV vaccine. On a scale of 0 to 100, vaccine acceptability was high at 87.8. On a scale of 0 to 11, the HPV knowledge score was relatively high at 6.65. Yet only 7% of men had started the three-dose HPV vaccine series. And among 1359 men who had not been vaccinated, only 4% had been offered the vaccine by their healthcare provider, although half of all men had been tested for a sexually transmitted infection by their healthcare provider. Two thirds of men said they were unsure if their provider would want them to get the HPV vaccine.
Among men who had not been vaccinated against HPV, statistical analysis linked three factors to lower vaccine acceptability (Figure 2): (1) concerns about HPV vaccine safety (in fact the vaccine is very safe), (2) perceived personal resistance to HPV infection (all sexually active people are vulnerable to HPV infection), and (3) shame about HPV infection or disease. Three factors favored higher HPV vaccine acceptability: (1) vaccine recommendation by a healthcare provider, (2) greater worry about getting infected with HPV, and (3) being tested for a sexually transmitted disease in the past year.
Figure 2. Young gay and bisexual men using a social/sexual Web site tended to find HPV vaccination unacceptable if they worried about vaccine safety or the shame of HPV infection, or if they believed they had little chance of getting infected with HPV. Men tended to find HPV vaccination acceptable if their provider recommended it, if they had a recent test for a sexually transmitted disease (STD), or if they worried about getting HPV infection.
Separate statistical analysis identified three factors that predicted actually getting vaccinated against HPV: (1) Being tested for a sexually transmitted disease in the past year more than tripled the odds of vaccination. (2) Telling a healthcare provider about being gay or bisexual tripled the odds of vaccination. (3) Higher HPV knowledge raised chances of HPV vaccination 40%.
Although this nationwide U.S. group of young, sexually active gay or bisexual men had a good understanding of HPV infection and found HPV vaccination highly acceptable, only 7% had been vaccinated. And only 4% of their healthcare providers had offered the HPV vaccine, even though U.S. health authorities recommend HPV vaccination for gay or bisexual men with or without HIV infection up to age 26.2
HPV is the most frequent sexually transmitted infection in the United States; it can cause anal cancer, cervical cancer, other cancers, and genital warts; and HPV vaccines available in the United States prevent infection with the most dangerous types of HPV. For all these reasons, all boys and girls should get the HPV vaccine at age 11 or 12.2 Young women and men should get the vaccine if they have not already been vaccinated or if they have not had the three required doses. It is especially important for sexually active young men and women to get vaccinated to protect themselves from HPV.
The 1457 gay or bisexual men who completed this survey were sexually active, usually had more than one partner in the past year, and did not always use condoms when having anal sex. As a result they ran a high risk of HPV infection. These men listed three main reasons for not getting the HPV vaccine.
Among men who had not had the HPV vaccine, only 4% said their healthcare provider offered the vaccine. Providers should do a much better job determining whether young patients have had the vaccine and, if not, providers should recommend it. This finding shows that people cannot always rely on their healthcare provider to recommend the HPV vaccine or other vaccines like hepatitis B virus vaccine or other procedures like testing for sexually transmitted diseases.
If you are an adolescent or a young man or woman and don't know whether you've had all three doses of the HPV vaccine, ask your healthcare provider. If you determine that you have not had all three HPV vaccine doses, ask your provider to set up a schedule to begin or complete your HPV dosing. U.S. health authorities say adolescents who have not started having sex -- as well as youngsters who have started -- should get the HPV vaccine.2
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