Health System Barriers to Human Papillomavirus Vaccination Among Young Men Who Have Sex with Men in Two U.S. Cities

Carrasco, Steven

Tuesday, June 10, 2014

International Ballroom

Steven Carrasco, MPH¹, Pamina Gorbach, DrPH², Priya Bhagwat, BS¹, Adam Parrish, MA³, Tom Collins, BS³, Beau Gratzer, MPP⁴, Robert Bolan, MD⁵, Michael Zimmerman, BA⁶, Lauri Markowitz, MD⁷, Peter Kerndt, MD, MPH⁸ and Elissa Meites, MD, MPH⁷, 1Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 2Fielding School of Public Health, Department of Epidemiology, UCLA, Los Angeles, CA, 3Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, 4Department of Research, Howard Brown Health Center, Chicago, IL, 5Health Services Department, Los Angeles Gay and Lesbian Center, Los Angeles, CA, 6Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, 7Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 8Sexually Transmitted Disease Program, Division of HIV/STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA

Background: In 2011, the Advisory Committee on Immunization Practices recommended quadrivalent human papillomavirus (HPV) vaccine for routine immunization of males at age 11 or 12 years and through 26 years for men who have sex with men (MSM). Because little is known about factors affecting vaccination among young MSM (YMSM), we assessed potential barriers to HPV vaccination in this population.

Methods: The Young Men’s HPV (YM-HPV) study is a cross-sectional study of rectal and oral HPV among YMSM aged 18–26 years enrolled from three STD clinics in Los Angeles and Chicago. A self-administered computerized questionnaire was completed by 541 YMSM during July 18, 2012 through July 17, 2013. Associations between HPV vaccination status, demographics, insurance status, and behaviors were assessed using chi-square and Fisher’s exact tests.

Results: Participants were Latino or mixed Latino (38.7%), White (26.8%), or Black (18.4%); median age was 23 years, and about half reported health insurance (53%). Commonly reported barriers to HPV vaccination were cost (24.8%), insurance not covering vaccination (16.8%), doctor not recommending vaccination (11.6%), safety concerns (9.8%) and not knowing where to get vaccinated (8.9%). Among vaccinated YMSM, more had attended private clinics (43.2%) or multiple clinics (31.8%) in the past year than LGBT clinics (13.6%) or public clinics (11.4%); more YMSM were vaccinated who had visited private clinics than these other settings (22.1% vs. 14.0%, 13.9% or 5.7%, respectively, overall p=0.02). More with health insurance had received HPV vaccination than those without insurance (17.8% vs. 11.5%, p=0.07).

Conclusions: Cost and lack of insurance were the most commonly reported barriers to HPV vaccination among YMSM. Vaccine uptake might be improved by enhancing support for HPV vaccination in LGBT and public clinics, as few YMSM attending such clinics were vaccinated. Encouraging doctors to recommend HPV vaccine to all YMSM may also increase vaccination rates.

WP 29 Health System Barriers to Human Papillomavirus Vaccination Among Young Men Who Have Sex with Men in Two U.S. Cities