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Editor,—Estimates of the prevalence of hepatitis B virus (HBV) markers among men who have sex with men (MSM) range from 5% to 81%, and the prevalence of HBV surface antigen varies from 1% to 11%.1,2 Despite a safe and effective vaccine against HBV, sexually active MSM are not vaccinated adequately.2–5 Few empirical data describe the factors associated with HBV vaccination among MSM. We conducted a study to identify correlates of HBV vaccination among MSM that could inform future interventions designed to enhance HBV vaccination.
Data were collected at two male “gay” bars in Birmingham, Alabama, USA, using a brief, self administered questionnaire. Of 130 bar patrons, our sample consisted of 111 respondents who identified themselves as MSM and knew their vaccination status. Their average age was 31 years with a range of 18–48 years. The sample was disproportionately white (91.9%); 42% reported being vaccinated for HBV.
Based on bivariate associations nine characteristics were significantly associated with HBV vaccination—age; condom use; factual knowledge of hepatitis; HBV knowledge; HCV knowledge; HBV vaccination knowledge; number of sources for information about hepatitis; information from a physician; and information from professional training. Two factors retained significance when adjusting for all other factors in a multivariate logistic regression model: respondents' HBV vaccination knowledge (OR=10.18; 90% CI = 4.0–25.37, p = 0.0001) and their frequency of condom use (OR=6.1; 90% CI = 2.54–14.67, p = 0.0007). The predictive power of the model (χ2 = 42.33; p = 0.0001) was high, correctly classifying 76.4% of the respondents into their actual vaccination status categories (p = 0.0001). These findings suggest that respondents with high HBV vaccination knowledge and condom use are significantly more likely to have been vaccinated against HBV.
There is need to enhance awareness and facilitate vaccination among this high risk population for HBV infection; 32% reported having no information about hepatitis. Many respondents reported engaging in behaviours that put them and their sexual partners at risk for HBV infection; 95.5% and 30.6% reported using a condom less than 50% of the time during oral and anal intercourse, respectively. Given that HBV transmission usually results from mucous membrane exposure to infectious body fluids, including semen,6 the failure to vaccinate this high risk population is a missed opportunity to prevent disease.
Our findings suggest that MSM lack information about HBV risk and vaccination, and are engaging in behaviours that put them at risk for HBV infection. It is critical to develop innovative interventions that encourage condom use and increase knowledge of HBV vaccination among MSM.
This study was supported financially by the researchers themselves. We wish to thank the participants, the bar owners, managers, and staff.