Integrating HPV vaccination into HIV and STI prevention and testing services may be an effective strategy for increasing vaccination rates among minority MSM.
“Current epidemiological evidence suggests that Black men who have sex with men (MSM) and transgender women are disproportionally impacted by anal cancer,” Christopher Wheldon, PhD, MSPH, MEd, notes. “Anal cancer is caused by HPV infection, mostly by type 16, and can be prevented through vaccination. That is why it’s so important that public health programs increase uptake of HPV vaccination in these medically underserved populations.”
For a study published in the Journal of Racial and Ethnic Health Disparities, Dr. Wheldon and colleagues examined predisposing, enabling, and need-based factors associated with HPV or HPV vaccination intentions among ethno-racial minority MSM and gender-expansive natal males.
“Andersen’s model of healthcare utilization is a widely used theory in public health that helps us understand the factors that lead to the utilization of health services,” Dr. Wheldon explains. “My colleagues and I sought out to investigate factors related to receiving HPV vaccination among Black and Hispanic/Latino sexual and gender minority adults. For those who were not vaccinated, we examined one of the best predictors of future vaccination—their intentions.”
Missed Vaccination Opportunities During Routine Care
The researchers examined survey data from 299 Black and Hispanic MSM and gender-expansive US adults aged 18-30 (average age, 26.5). Most identified as Hispanic or Latino (66.2%), cisgender men (93.3%), gay (80.0%), and unmarried (93.0%).
General vaccine attitudes were positive, according to the study results. Most participants (84.6%) had health insurance, had undergone a routine visit in the previous year (77.6%), and were recently tested for STIs (77.6%). The average age of first anal sex encounter with a male partner was 17.6, and most reported recent anal sex (70.1%). Approximately 4% had ever been diagnosed with anogenital warts.
Less than half of respondents (45.5%) had started the HPV vaccine series, or receipt of at least one dose. Of those who were unvaccinated, 14.2% were unlikely to start the HPV vaccine series within the next 12 months, 56.3% were undecided, and 29.4% likely.
“We found that more than half of the sample had not initiated HPV vaccination, and—in that group—most said they were undecided about HPV vaccination,” Dr. Wheldon says. “It is important to point out that most participants in this sample had health insurance and had been taking PrEP to prevent HIV at some point. That shows that they were engaged in healthcare, yet HPV vaccination somehow slipped under the radar.”
The researchers identified three significant predictors of HPV vaccination, according to Dr. Wheldon. “Having had a routine checkup in the previous year, having a previous diagnosis of anogenital warts, and having positive attitudes about vaccines—in general, not just the HPV vaccine—were all independently associated with getting at least the first shot (Table).”
Educating At-Risk Groups & Leveraging Existing Services
The results “reiterate how important it is for physicians to recommend HPV vaccination to adult patients,” Dr. Wheldon says.
“If a patient is starting PrEP or coming in for an HIV test, recommend HPV vaccination, too,” he explains. “Tell them about how HPV vaccination also prevents anal cancer and that having anal sex is a risk factor for anal cancer. Currently, MSM and transgender women know more about cervical cancer than anal cancer. We need to educate this population about how they will directly benefit from HPV vaccination.”
Dr. Wheldon believes the existing engagement in care seen in the study is one strategy for increasing HPV vaccination rates.
“I would like to see more research focused on how we can integrate anal cancer prevention into existing HIV services,” he says. “Many MSM and transgender women are engaged in health services related to HIV prevention and care. Can we make small changes to make sure these populations benefit from cancer prevention efforts? I think the answer is yes. We just need to figure out how to do it more effectively.”
