HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study

Abstract

The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Gay, bisexual, and other men who have sex with men (GBM) living with HIV are disproportionately impacted by HPV-associated anal cancer, with rates about 100-fold that of the general population. Fortunately, HPV vaccination has proven efficacy in preventing both anogenital warts (condyloma) in males and anal pre-cancers (anal intraepithelial neoplasia; AIN) in GBM up to the age of 26. We conducted in-depth, semi-structured interviews with 25 HIV-positive gay men in Toronto to gain an understanding of their knowledge and experiences related to HPV and the HPV vaccine. These participants were part of The HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, and received invitations to have anal cancer screening from their primary care doctors. Interviews were analyzed following a Grounded Theory Approach. Most participants had not received the HPV vaccine. Men described a lack of prior knowledge of the health consequences of HPV for GBM living with HIV and financial barriers to vaccine access. Participants did not articulate concerns about vaccine safety. Men frequently reported initial beliefs that HPV was predominantly—or exclusively—a risk for females or young girls, and thus they had not considered the vaccine to be necessary. Some participants remained uncertain if the current availability of the vaccine, and their newly acquired knowledge of its importance, was “too little, too late” because of their age and/or HPV exposure. Improving access and uptake of HPV vaccination requires addressing both financial barriers to access as well as increasing HPV health literacy levels, particularly by reframing the long-standing gendered associations of HPV. Physicians should provide clear, tailored messages regarding HPV vaccination.

Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians’ challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men

“…In addition to interviews with 25 GBM-LHIV patient-participants in Toronto, Canada, who had received anal cancer screening through HPV-SAVE, we interviewed 15 health service providers in Toronto, Ottawa and Vancouver, Canada. In this article, we focus on the data collected with providers to build upon recently published analyses of patients’ accounts of anal cancer screening [28] and HPV vaccination practices [16].…”

“…Though these existing guidelines make recommendations about who should be vaccinated, in many contexts this guidance does not directly translate into what is actually made available via public programs. For example, in Canada, since 2016 most provincial insurance programs cover HPV vaccination for men who have sex with men only up to the age of 26 [16]. Otherwise, the vaccine cost ranges from $420 CAD (Gardasil-4) to over $560 CAD (Gardasil-9) for all three doses, which can be paid for with private health insurance for those who have adequate coverage, or out of pocket for those who are able to afford the costs [16].…”

“…This body of research is primarily quantitative and has focused on the significance of provider recommendations for younger women and men. An exception to this is the recently published qualitative research from the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study on the vaccine decision-making of older HIV-positive GBM patients in Toronto, Canada, who had received anal cancer screening [16]. Based on qualitative interviews with 25 HIV-positive GBM patients who had received anal cancer screening, Grace and colleagues explored the interrelated barriers to HPV vaccination including limited vaccine literacy and financial concerns [27].…”

“…Patients’ concern with HPV risk and anal cancer was highly structured by their physicians’ recommendations on these matters [28]. GBM-LHIV who said that the HPV vaccination was not strongly recommended to them by their doctor did not get vaccinated [16].…”

A tale of two epidemics: gay men's mental health and the biomedicalisation of HIV prevention and care in Toronto

“…, Grace et al . ). From a prevention perspective, studies have confirmed that HIV‐positive persons who have achieved an undetectable viral load or ‘undetectability' (i.e.…”