Barriers to achieving routine HPV vaccination among adult men who have sex with men

Men who have sex with men (MSM) are at increased risk of anal cancer as a result of prevalent anal HPV infection. Routine vaccination is recommended for all MSM up through age 26; however, vaccine uptake among this population is low. A mixed-methods approach was used to explore how issues surrounding sexual orientation may act as barriers to vaccine uptake among MSM (ages 18-26). A cross-sectional survey (N=197) of MSM in fall 2010 provided data for quantitative descriptive analysis. Qualitative interviews with a community-based purposive sample of MSM add context to the quantitative results. Results of the survey indicate that 23% of men expressed low self-efficacy in getting vaccinated if they had to talk to their healthcare provider (HCP) about their sexual orientation. Approximately 28% expressed discomfort in discussing the HPV vaccine with a HCP if they had to answer questions about their sexual behavior. Self-efficacy was strongly associated with discomfort in discussing sexual behavior with a HCP (Pearson r =-0.51, p<.0001). The qualitative phase is nearing completion (April 2014) and the emerging themes from the completed interviews (n=7) surround issues of privacy and trust. Participants expressed concern regarding the sensitivity and competence of HCPs in dealing with their sexual health issues. They voiced concerns about being judged for asking for HPV vaccine and for disclosing their sexual orientation. Achieving routine vaccination of MSM up through age 26 may require use of alternative settings for vaccination including the use of trusted community-based organizations serving LGBT populations.