This study aimed to ascertain the attitudes of men who have sex with men (MSM) to the human papillomavirus (HPV) vaccine and to determine the age at which MSM would be willing to ask for the HPV vaccine in relation to their age of sexual debut. Of 205 MSM attending the Melbourne Sexual Health Centre between December 2007 and January 2008, 200 (98%; median age 27 years) completed the study questionnaire. Only 30% were aware that there was a vaccine available for protection against infection with certain HPV types. When informed of the increased risk of anal cancer among MSM, 47% of MSM indicated that they would be willing to pay $A450 for the vaccine course. A total of 93% indicated that they would be willing to disclose that they were MSM to a health professional in order to obtain the vaccine for free, but not until a median age of 20 years: 2 years after the median age of sexual debut (18 years) and after a median of 15 sexual partners. If the HPV vaccine is targeted to MSM, the challenge will be for MSM to be vaccinated before they acquire HPV infection.
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Studies have demonstrated a high prevalence of human papillomavirus (HPV) infection among men who have sex with men (MSM), together with an increased risk for anal cancer linked to infection with high-risk HPV types.1–3 Although there have not as yet been any published studies demonstrating the efficacy of the HPV vaccine in preventing anal cancer, it is plausible that the vaccine would be protective.
While a number of studies have examined the acceptability of HPV vaccination among females, we are not aware of any that examine the acceptability of this vaccine among MSM.4 5 The aim of this study is to provide data on the attitudes of MSM to the HPV vaccine. Furthermore, we aim to determine the age at which MSM first become sexually active, the age at which they would have felt comfortable disclosing their sexuality to a healthcare provider in order to receive the vaccine and the number of sexual partners they had had by this time to assess the likelihood of exposure to HPV infection prior to vaccination.
A cross-sectional survey of MSM attending the Melbourne Sexual Health Centre, Victoria, Australia, between November and December 2007 was carried out. Those eligible were any men attending the clinic who were aged 18 years or over who reported sex with a man in the prior 12 months and who were capable of completing the questionnaire unassisted.
Participants were informed that a vaccine is available against certain types of HPV and they were asked to assume that this would prevent most cases of anal and genital warts and 80% of cases of anal cancer. They were informed that the total cost for the vaccine is $A450 (approximately £220). They were then asked whether they would be willing to pay for the vaccine under these circumstances. Participants were provided with a list of sexual activities and asked to indicate the age at which they first engaged in each of these with another man.
During the recruitment period, 205 MSM attended the centre with 200 (98%) consenting to participate in the study. The median age of participants was 27 years (range: 19–71 years). In total, 74% had heard of the “wart virus” or HPV; 30% had heard of the vaccine for HPV, while 54% were unsure and 47% of men indicated that they would be willing to pay $A450 for the HPV vaccine.
Altogether, 93% of the participants indicated that they would be willing to disclose their sexuality to obtain the vaccine if by so doing they could obtain the HPV vaccine free of charge. The median age at which they would have made this disclosure was 20 years (range: 12–60 years). The ages at which participants first engaged in specific sexual activities are shown in table 1.
The median number of men the participants had any form of sexual contact with up until the age at which they felt comfortable disclosing their sexuality to a health professional to access the HPV vaccine was 15 (range: 0–2500). Of the 178 men who provided complete data, only 31% (n = 55) indicated that they first experienced receptive anal sex after the age at which they would have been willing to disclose their sexuality to a provider.
In this study MSM were keen to have the HPV vaccine when informed of its role in preventing genital warts and possibly anal cancer. Nearly half of the participants indicated that they would be willing to pay for the vaccine. Almost all men said that they would be prepared to disclose their sexuality to a health professional in order to obtain the vaccine free of charge. However, the age at which they would have been willing to do this was on average 2 years after their sexual debut and after a median of 15 sexual partners.
We believe this to be the first study that specifically examines the attitude of MSM to the HPV vaccine. A limitation of the study is that it surveyed men attending a health service, which could have biased towards more health conscious men. Our study suggests that were the vaccine to be offered free of charge to MSM only if they disclosed their sexuality to a health provider, the probability of prior exposure to genital HPV infection would be high.6 The dilemma for policy makers will be whether to provide the vaccine to all boys in order to reduce the risk of anal cancer in MSM. Any programme targeting MSM for HPV screening will need to address the low levels of awareness of HPV and anal cancer seen in some studies of MSM.7 8
When informed of the risk of anal cancer, men who have sex with men are in favour of being vaccinated against human papillomavirus.
If such men need to disclose their sexuality to a healthcare provider in order to access the vaccine, it is likely many will already have been exposed to the virus.
We would like to thank all the staff at the Melbourne Sexual Health Centre who assisted in recruitment. Thanks also to all the men who participated in this study.
Competing interests: None.
Ethics approval: Ethics approval for the project was obtained from the Alfred Hospital Human Research Ethics Committee.
Contributors: All authors contributed to the design of the study, drafting of the questionnaire, and writing and editing of the manuscript. DS was responsible for recruitment and data collection. DS, MYC and CB analysed the data.