Human papillomavirus vaccination is recommended for men who have sex with men through age 26, but some opportunities for meeting this recommendation are missed because men do not visit health care providers or do not tell them of their same-sex attraction or behavior.[1] In a large survey of U.S. men who have sex with men, nearly nine in 10 respondents aged 18–26 reported having received any health care in the previous 12 months, but only six in 10 had told the provider that they were attracted to or had sex with men. Sexual identity and self-reported HIV status were the characteristics most strongly associated with these outcomes: The likelihood of both outcomes was lower among men who considered themselves heterosexual than among those who identified themselves as gay, and was higher among those who said they had HIV than among men who were not infected.

Researchers assessed the frequency and correlates of health care use and disclosure of same-sex attraction or behavior using data from the 2008 National HIV Behavioral Surveillance System, a survey conducted in 21 cities among men who have sex with men. Survey participants were recruited at sites frequented by such men (e.g., bars, clubs and social organizations), and responded to an anonymous, interviewer-administered questionnaire. Descriptive, bivariate and multivariate analyses were conducted on a sample of 2,941 respondents aged 18–26.

Most of the men were black, Hispanic or white (roughly one-third each) and had at least some postsecondary education (six in 10). Sixty percent had incomes above the poverty level, and the same proportion had some kind of health insurance. Virtually all had had sex with a male partner in the past year. Seventy-six percent of the men identified themselves as gay, 22% as bisexual and 2% as heterosexual. Some 89% had made a health care visit in the past year (i.e., they had seen a provider or had a test for HIV or syphilis); 61% overall (65% of those who had seen a provider) had told a provider that they were attracted to or had sex with men. Five percent said that they were HIV-positive.

Results of a multivariate analysis controlling for all background and sexual health–related characteristics suggested that men who considered themselves heterosexual had lower odds of having used health care than did those who said they were gay (odds ratio, 0.3). The odds of health care use were elevated among those with a high school diploma or any postsecondary education (1.9–2.6), those who had health insurance (2.5) and those with HIV infection (4.6).

Bivariate analyses revealed that among men who had made a health care visit in the last year, the proportion who had disclosed their same-sex attraction or behavior to the provider varied, sometimes considerably, among subgroups. Ninety-two percent of HIV-positive men had made such a disclosure, compared with 67% of those who were uninfected or did not know their HIV status. The proportions who had disclosed were significantly lower among bisexual and heterosexual men (51% and 23%, respectively) than among gay men (70%). Smaller, but still significant, differences were apparent by age (54% of 18-20-year-olds, compared with 68% of men aged 21–26), race and ethnicity (60–63% of Hispanics and blacks vs. 69% of whites), education (69% of those with more than a high school education vs. 62% of those who had not graduated from high school) and poverty status (69% of men above the poverty level vs. 59% of those at or below poverty).

The researchers point out that the survey participants were not necessarily representative of all U.S. men who have sex with men, that the data do not indicate whether men's disclosures were to providers who offer vaccines and that males younger than 18—"the primary target population for adolescent vaccinations"—were not included. Despite these limitations, they conclude that the findings "suggest that … health care providers have opportunities to reach many sexually active [men who have sex with men] to recommend [human papillomavirus] vaccine and other sexual health care." At the same time, "gaps in disclosure to health care providers also suggest potential missed opportunities." They encourage further research to explore how "supportive health care environments" can be created and maintained so that men who have sex with men can comfortably discuss their sexual identity and behavior with providers, and thus increase their chances of getting recommended care.—D. Hollander

Reference

1. Meites E et al., Health care use and opportunities for human papillomavirus vaccination among young men who have sex with men, Sexually Transmitted Diseases, 2013, 40(2):154–157.