Three-quarters of participants in a national survey of gay and bisexual men said that they would be willing to get vaccinated against human papillomavirus (HPV) if the vaccine received government approval for use in men, and predictors of this response included several potentially modifiable behaviors and beliefs.1 For example, men who had had five or more sexual partners were more likely than those reporting fewer partners to say that they would be willing to get vaccinated, and acceptability increased with men’s perception of the severity of HPV-related disease and of the vaccine’s effectiveness. At the same time, one in five men had not heard of HPV before the survey, and those who were familiar with it displayed low levels of knowledge about the consequences of infection with the virus.
The online survey, conducted in January 2009 among 18–59-year-old men, assessed participants’ awareness of, beliefs about and perceptions of a wide range of issues related to HPV and the vaccine, as well as their demographic and health characteristics. (Later in 2009, HPV vaccination was approved for use in males aged 9–26 to reduce their risk of acquiring genital warts, but it was not recommended for routine use in men.2) To explore vaccine acceptability among gay and bisexual men, researchers analyzed data from the 306 respondents who categorized themselves as gay or bisexual. They used multivariate logistic regression to identify predictors of acceptability.
The majority of respondents were white (81%) and younger than 50 (60%), lived in urban areas (93%) and had health insurance (86%). Fifty-six percent had not been vaccinated against hepatitis B or were not sure if they had been. Two-thirds had first had sex at age 16 or later, and nine in 10 had had at least five partners. Seventeen percent were HIV-positive; 32% had ever had another STD; and 2% had had oral, anal or penile cancer or anal or penile lesions.
Although 79% of respondents had heard of HPV, this group answered an average of only half of the survey’s nine knowledge questions correctly. Three-quarters of men who were aware of HPV knew that it is transmitted sexually, and the same proportion knew that it is a common infection. Only six in 10, however, knew that it can lead to health problems for men, and fewer than half were aware that it can cause genital warts and cancer.
Respondents’ levels of knowledge about HPV-related disease and concern about getting such disease were low—on average, 1.8 and 1.6, respectively, on scales of 1-–4. However, participants thought that HPV-related disease would have fairly severe consequences and that they would be quite regretful if they declined to be vaccinated and then got HPV (means, 3.3–3.4 on scales of 1–4); they also thought that the vaccine is moderately effective (3.0 on a scale of 1–5). Men thought that if the vaccine were available, some barriers would impede access to it; one-third believed that their physician would recommend it, but half were unsure.
Seventy-four percent of survey participants said that they would be willing to receive HPV vaccination. The multivariate analysis revealed that men who had had five or more partners were more likely than those reporting fewer partners to give this response (odds ratio, 3.4), and those who thought that their physician would recommend vaccination and those who were unsure were more likely to do so than were those who said their physician would not recommend it (12.9 and 3.2, respectively). In addition, respondents’ likelihood of saying that they would be willing to get vaccinated was positively associated with their perception of the severity of HPV-related disease (1.9) and of the vaccine’s effectiveness (2.0), and with their anticipated level of regret if they chose not to receive vaccination and subsequently became infect-ed with HPV (2.4).
The researchers conclude that despite the study’s limitations—particularly, its measurement of men’s willingness to receive a -vaccine that had not yet been licensed for use in men—it demonstrates that "modifiable beliefs…may be important to future communication efforts about HPV and HPV vaccine among gay and bisexual men." However, they point out that the vaccine likely is most effective if individuals receive it before initiating sexual activity, but that gay and bisexual men typically do not disclose their sexual orientation to others until after they have had sex with a male. As a result, these men— in the researchers’ words, the "ideal" population to target—may be difficult to identify. Another option, the researchers suggest, which would be similar to the strategy used for vaccinating females, would be "to target all males at an early age before sexual intercourse."—D. Hollander