While the focus for clinicians providing health services for men who have sex with men (MSM) has long been HIV care, the burden
of other sexually transmitted infections (STIs) among men using pre-exposure prophylaxis (PrEP) point to the need for more comprehensive sexual health services.
One STI of particular concern for public health is human papillomavirus (HPV), as it is is the most prevalent among adults in the United States.
The US Food and Drug Administration (FDA) recently expanded
guidelines for adult HPV vaccination in hopes of increasing uptake of the highly effective vaccine. The HPV vaccine is in such high demand in some areas of the world that the effectiveness of single-dose
vaccination has been an area of scientific exploration in recent years.
The investigators of a new study, published in the Journal of Community Health,
have identified that misinformation and limited clinician communication around HPV risk among MSM are some barriers to vaccination.
The study team conducted semi-structured interviews with 38 MSM living in New York City between 24 and 27 years of age in order to evaluate knowledge and communication around HPV.
The study authors qualified the population interviewed as diverse in terms of race, income, sexual identity, and education. Enrollment ensured near equal proportions of black (26.3%), Hispanic (26.3%), Asian (23.7%), and white (23.7%) individuals.
Most people interviewed did not have HIV (92.1%). Approximately half (55.3%) identified as exclusively homosexual.
Interviewees had difficulty distinguishing HPV from other STIs, such as HIV. Many had some degree of knowledge but conceded not being entirely sure about precise details. A common conflation with HIV was the sense that HPV could be transmitted through blood.
Additionally, several participants incorrectly believed that HPV was exclusively experienced by women.
Importantly, it emerged from the interviews that health care providers did not spend adequate time explaining the importance of receiving the HPV vaccine. Even among participants who took HPV seriously,
“No doctor has ever brought [HPV] up to me. And I’ve always had to advocate for this…I read somewhere like gay men need to get this because you can get anal cancer, so I went to my doctor, and she was like ‘Oh I guess that’s technically correct,’ and I was like ‘Okay so vaccinate me,’ and she was like ‘Well, your insurance isn’t gonna cover it.’ So I ended up getting it, but I had to pay for it out of pocket,” one participant said.
When MSM initiated the HPV vaccine with the clinician intention of administering a 3-dose series, it appeared health care providers did not sufficiently follow-up.
“I remember getting 1 shot…And I know that it’s supposed to be more I just don’t know if I ever got the other ones,” a participant reported.
The results indicate that young MSM have mixed knowledge around HPV, including a widespread sense that vaccination is only necessary for women.
“These findings point to an ongoing need to expand health care approaches for SMM [sexual minority men] beyond HIV, which has been almost an exclusive focus of sexual minority healthcare for decades,” the authors concluded.
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