Factors affecting hepatitis vaccination refusal at a sexually transmitted disease clinic among men who have sex with men

BACKGROUND: Men who have sex with men (MSM) attending sexually transmitted disease (STD) clinics should be considered candidates for hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination. However, vaccination rates in STD clinics remain less than optimal. GOAL: The goal was to identify factors that affect HAV and HBV vaccination refusals. STUDY DESIGN: A survey was administered to MSM eligible for the vaccinations attending an STD clinic. Vaccines were offered at the end of the clinic visit. RESULTS: Rates of refusal of HAV (RefuseA) and HBV (RefuseB) vaccinations were 36% and 38%. Health motivation was associated with acceptance, while clinical barriers such as "want to test first for immunity," and "want to talk to own doctor first" were associated with refusal. "Not enough time this evening" was most strongly predictive of refusal, relative to strongly disagree (risk ratios [RRstrongly agree] and 95% confidence limits for RefuseA and RefuseB were 2.69 [1.43, 5.05] and 2.02 [1.05, 3.87], respectively). CONCLUSIONS: To increase acceptance, patients less health-motivated should be identified for prevaccination counseling. Some perceived barriers such as time may be a partial excuse; staff should identify and address other perceptions that may be influencing patients' decisions.     

Psychosocial predictors of hepatitis B vaccination among young African-American gay men in the deep south

BACKGROUND: Despite recommendations for vaccination against hepatitis B virus (HBV) of men who have sex with men (MSM), most remain unvaccinated. GOAL: The goal of this study was to identify attitudes and beliefs associated with vaccination against HBV among black MSM. STUDY DESIGN: The Birmingham Vaccine Acceptance Questionnaire was used to collect data from gay bar patrons. RESULTS: Of the 143 participants, nearly 42% reported at least one dose of HBV vaccine. In multivariable analysis, characteristics associated with vaccination were a decreased perception of barriers to HBV vaccination (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.22-0.61; P = 0.001); increased perceived medical severity (OR, 5.34; 95% CI, 2.38-11.96; P = 0.001) and personal severity (OR, 2.22; 95% CI, 1.38-3.56; P = 0.006) of HBV infection; and increased perceived general medical self-efficacy (OR, 9.22; 95% CI, 3.52-24.11; P = 0.0001) and personal self-efficacy (OR, 2.3; 95% CI, 1.14-4.63; P = 0.008) to complete the three-dose series. CONCLUSIONS: Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing perceived severity of HBV infection and self-efficacy to complete the vaccine series.     

Acceptance of hepatitis B vaccination among adult patients with sexually transmitted diseases.

BACKGROUND: Sexually transmitted disease (STD) clinic patients are at risk for hepatitis B virus infection, but have been relatively neglected in terms of hepatitis B virus (HBV) immunization. Acceptance of HBV vaccine among patients attending an STD clinic was examined. GOAL: To evaluate potential predictors of HBV vaccine acceptance. STUDY DESIGN: In this study, 99 patients attending an STD clinic completed a brief questionnaire that addressed knowledge of STD and vaccines as well as sexual behavior. After the questionnaire, each patient was offered HBV vaccine, then interviewed to assess reasons for acceptance or refusal. RESULTS: Among the patients in this study, 23% accepted the vaccine and 11% reported prior vaccination. Acceptors were younger, had less education, and used condoms less frequently than those who refused vaccination. The reasons given for acceptance or rejection typically involved health beliefs related to infection or vaccination. CONCLUSION: The findings indicate an unacceptably low rate of HBV vaccine acceptance in a group at high risk for infection. However, some of the reasons for refusal may be modifiable through brief, targeted interventions.     

Viral hepatitis among young men who have sex with men: prevalence of infection,risk behaviors,and vaccination

BACKGROUND: Men who have sex with men (MSM) are at risk for acquiring hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). GOAL: The goal was to describe the seroprevalence of and risk factors for viral hepatitis, the frequency of vaccination against HAV and HBV, and reasons for lack of vaccination among young MSM. STUDY DESIGN: We performed hepatitis serologies on 833 MSM aged 15 to 29 years who attended public venues in King County, Washington. RESULTS: While 14.6% were HAV-immune due to vaccination, 13.9% had prior HAV infection; 57.9% were susceptible and 13.5% had unclear status. While 24.5% were HBV-immune due to vaccination, 13.3% had prior HBV infection; 44.2% were susceptible and 18.0% had unclear status. Prior HBV infection was associated with prior HAV infection. Men unvaccinated against HAV or HBV were unaware of the vaccines or had never been offered vaccination or perceived themselves at low risk for infection. Among 10 HCV-seropositive men, 70.0% reported injection drug use. CONCLUSION: MSM must be vaccinated at an early age to prevent acquisition of HAV and HBV. Given the frequency of coinfection with HAV and HBV, a combined vaccine would be useful in this population.     

Factors associated with testing for hepatitis C in an internet-recruited sample of men who have sex with men

BACKGROUND: Nearly 4 million individuals in the United States (1.8%) have been infected with hepatitis C virus, yet few are aware of their infection. GOAL: To identify correlates associated with hepatitis C virus testing among a sample of men who have sex with men. STUDY DESIGN: Internet communications were used for solicitation and collection of data, using a 31-question survey. RESULTS: When the study was restricted to men who have sex with men in the United States (n = 381), 95% of the respondents (n = 361) reported at least one risk factor for hepatitis C virus transmission, 39% of these respondents (n = 140) reported having been tested for hepatitis C virus. Testing was associated with a history of nonsexual risk behavior, increased knowledge of the hepatitis C virus, and healthcare provider communication. CONCLUSION: A significant proportion of at-risk respondents had not been tested. Interventions are needed to increase hepatitis C virus knowledge in the community of men who have sex with men, and to encourage providers to communicate about hepatitis to the men in this group who screen as high risk on the basis of their risk behaviors.     

HIV, sexual risk, and ethnicity among men in England who have sex with men

OBJECTIVES: To examine ethnic group differences in HIV testing history and sexual HIV risk behaviours that may account for such differences, among men in England who have sex with men (MSM), in order to inform HIV prevention planning priorities. METHODS: A self completion survey in the summer of 2001 was carried out in collaboration with community based health promoters. Three recruitment methods were used: "gay pride" festivals, health promoter distributed leaflets, internet version advertised with gay service providers. The leaflet was produced with an alternative cover for targeted recruitment of black men. RESULTS: In a sample of 13,369 MSM living in England, 17.0% were from minority ethnic groups and 5.4% had tested HIV positive. Compared to the white British majority, Asian men were 0.32 times as likely to be living with diagnosed HIV infection, while black men were 2.06 times as likely to be doing so. Among men who had not tested HIV positive, Asian men were less likely to have sex with a known HIV positive partner, while black men were more likely to have insertive unprotected anal intercourse both with a partner they knew to be HIV positive and with a partner whose HIV status they did not know. CONCLUSIONS: Among MSM in England, HIV prevalence is higher among black men and lower among Asian men compared with the white British majority. Increased sexual HIV risk behaviour, especially exposure during insertive anal intercourse, accounts for some of this difference. HIV prevention programmes for MSM and African people should both prioritise black MSM.     

Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam.

In a pilot study by field-screening in two different sauna baths, a day-sauna and a night-sauna, 318 homosexual men were investigated for syphilis and hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs). Of the 134 visitors to the day-sauna 35.1% were seroreactive for syphilis, four (3%) carried HBsAg, and 95 (70.9%) anti-HBs. Of the 184 visitors to the night-sauna 33.2% were seroreactive for syphilis, 16 (8.7%), carried HBsAg, and 97 (52.7%) anti-HBs. The correlation between seroreactivity for syphilis and the presence of HBsAg amd anti-HBs was statistically significant.     

Syphilis, hepatitis A, hepatitis B, and cytomegalovirus infection in homosexual men in Antwerp.

In a homosexual communication centre in Antwerp 196 homosexual men were screened for seromarkers of syphilis, hepatitis A (HAV), hepatitis B (HBV) and cytomegalovirus (CMV). A comparison group consisted of 118 heterosexual men attending a venereal disease clinic in Antwerp. Treponemal antibodies were found in 7.1% of homosexual men, of whom half gave no history of past or present infection. Anti HAV was present in 43.3%, HBV seromarkers in 34.4%, and CMV antibodies in 71.2% of homosexual men. Hepatitis B surface antigen (HBsAg) was detected in eight homosexual men, but not in the heterosexual control group. Prevalence rates of infections other than HAV were significantly higher in homosexual men than in heterosexual men. Answers to a questionnaire were used to evaluate risk factors for different diseases, which were: duration of active homosexuality for all infections, promiscuity (greater than or equal to 10 partners in the past six months) for syphilis and hepatitis B, and anal intercourse for hepatitis B. Visiting saunas and travelling for sexual contacts also indicated a higher risk for STD, but were an indirect expression of promiscuity.     

男性非淋菌性尿道炎患者性病病原体的研究

应用培养、多聚酶链反应（ＰＣＲ）和抗原检测法对１０４６例非淋菌性尿道炎（ＮＧＵ）患者的前列腺液（ＥＰＳ）进行检测。结果显示：ＣＴ阳性为１２６例（１２．０４％），ＵＵ为１４９例（１２．２４％）、ＣＤ为１１２例（１０．７０％）、ＴＶ为３４例（３．２５％）、ＨＳＶ２为３２例（３．０５％）、ＭＨ为２１例（２．０％）。在１２６例ＣＴ阳性患者，混合感染７８例（５７．１４％），其中ＣＴ＋ＵＵ２８例（２２．２２％）、ＣＴ＋ＵＵ＋ＭＨ４例（３．１７％）、ＣＴ＋ＣＤ＋ＴＶ１２例（９．５２％）。本研究结果可为临床男性ＮＧＵ感染病因学诊断与治疗提供实验室依据。     

The HIV related risks among men having sex with men in rural Yunnan, China: a qualitative study

OBJECTIVES: To explore the characteristics and issues specific to HIV related risk behaviours among men who have sex with men (MSM) in rural China. METHOD: Qualitative study using semistructured in-depth interviews in Dali prefecture, Yunnan. 24 informants recruited through a local MSM network, snowballing and by word of mouth. The main outcome measures were themes identified as increased exposures and risks to HIV. RESULTS: Risk behaviour, social stigma, one child policy and concepts of traditional Chinese medicine (TCM) had significant roles in the spread of HIV in rural China. Many MSM lead a life with double identities in China and condom use was found to be variable with attempts to "rationalise" the risky behaviour being its major determining factor. Health seeking behaviours of genitourinary problems were infrequent and illogical, which were further held back by the existing healthcare system and lack of sensitivity expressed by the health professionals. CONCLUSIONS: Clear education messages to the general public while raising awareness among health professionals of the health risks and needs in MSM are essential in the prevention of the current HIV epidemic.     

High level of hepatitis B infection and ongoing risk among Asian/Pacific Islander men who have sex with men, San Francisco, 2000-2001

OBJECTIVES: This study examined serologic markers of hepatitis B virus (HBV) infection and immunity among young Asian/Pacific Islander men who have sex with men (API MSM) in San Francisco. METHODS: Participants were 496 API MSM, aged 18 to 29 years, recruited to participate in a cross-sectional survey using a random, venue-based, time-space sampling method. RESULTS: Of 489 subjects tested, 28.0% had evidence of past HBV infection, including 8.2% who were chronically infected; 24.9% were immune as a result of vaccination; and 47.0% were susceptible to infection. Self-reported vaccination history was low overall and discrepant with serologic findings. CONCLUSIONS: HBV infection persists as a significant health problem among API MSM as a result of childhood infection, low vaccination coverage in Asia and the United States, and continuing adult exposure through male-male sex. Although challenging, vigorous efforts are needed to increase vaccination coverage among adult API MSM.     

Factors associated with clinical and sub-clinical anal human papillomavirus infection in homosexual men.

OBJECTIVES--(I) to determine the relative sensitivities of clinical examination, cytology and HPV DNA hybridisation for the detection of anal human papillomavirus infection; and (ii) to examine various factors which may influence presentation of anal human papillomavirus infection in homosexual men. METHODS AND RESULTS--112 unselected homosexual men attending a Sydney STD clinic for routine screening underwent a complete anogenital and physical examination, during which blood samples (for haematological, serological and immunological investigations), rectal swabs (for culture of anal pathogens) and anal scrapes of the dentate line (for cytology and HPV DNA hybridisation) were collected. Papanicolaou-stained anal smears were examined for cytological abnormalities, including those indicative of HPV infection or anal intraepithelial neoplasia (AIN). HPV DNA was detected by high stringency dot hybridisations using radiolabelled HPV 6, 11, 16 and 18 DNA probes. Visible anal condylomata, situated either externally or in the anal canal, were present in 26% of these men; 46% had cytological evidence of HPV infection, and 19% of the smears showed evidence of mild to moderate dysplastic changes (AIN I-II). Detectable HPV DNA was present in 40% of the anal scrapes. By combining these results, a total of 73 men (65%) were found to have at least one of the indicators of HPV infection. These data, together with that relating to HIV antibody, immune status and past or present infection with other STDs, was correlated with information obtained from a questionnaire administered to the patients at the time of their clinical examination. CONCLUSIONS--In this study cytology was found to be slightly more sensitive than HPV DNA dot hybridisation for the detection of HPV infection in the anal canal, providing the full range of HPV-associated cytological changes were accepted as a basis for diagnosis. Clinical anal lesions were more likely to be detected in young men, men who had symptomatic HIV infection and those with a history of past anal wart infection. The latter group also had a higher incidence of cytologically apparent HPV infection in their anal smears. There was a significant association between the detection of HPV 16/18 and the presence of anal dysplasia, but there were no significant correlations between HPV infection or anal dysplasia and HIV antibody, immune function status, sexual practices or history of other STDs.     

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.     

Epidemiology of human immunodeficiency virus, viral hepatitis (B and C), treponema pallidum, and human T-cell lymphotropic I/II virus among men who have sex with men in Buenos Aires, Argentina

BACKGROUND: Human immunodeficiency virus (HIV) and sexually transmitted infections (STI) are prevalent among men who have sex with men (MSM). GOAL: To estimate the prevalence of HIV and STIs in this group. STUDY: A total of 694 MSM were tested for HIV, hepatitis B (HBV), hepatitis C (HCV), human T-cell lymphotropic (HTLV-I/II) viruses and Treponema pallidum infection. RESULTS: HIV, HBV, and T pallidum were detected in 13.8%, 37.7%, and 16.9% of subjects, respectively. Prevalences of 1.9% and 0.3% were detected for HCV and HTLV-I/II. A prior history of STI was the most predictor for HIV, HBV, and T pallidum. Use of illegal drugs, blood transfusion history, and multiple sexual partners were associated with HCV. The 2 most common co-infections were HBV/T pallidum and HIV/HBV. CONCLUSIONS: Infection with HIV, HBV, and T pallidum was elevated among MSM. Routine testing, education, vaccine-based prevention, and control programs need to be implemented in this high-risk population.     

Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya

OBJECTIVES:: To identify social and behavioral characteristics associated with sexual risk behaviors among male sex workers who sell sex to men in Mombasa, Kenya. METHODS:: Using time-location sampling, 425 men who had recently sold, and were currently willing to sell sex to men were invited to participate in a cross-sectional survey. A structured questionnaire was administered using handheld computers. Factors associated with self-reported unprotected anal sex with male clients in the past 30 days were identified and subjected to multivariate analysis. RESULTS:: Thirty-five percent of respondents did not know HIV can be transmitted via anal sex, which was a significant predictor of unprotected anal sex [adjusted odds ratio (AOR) 1.92; 95% confidence interval (95% CI), 1.16-3.16]. Other associated factors included drinking alcohol 3 or more days per week (AOR, 1.63; 95% CI, 1.05-2.54), self-report of burning urination within the past 12 months (AOR, 2.07; 95% CI, 1.14-3.76), and having never been counseled or tested for HIV (AOR, 1.66; 95% CI, 1.07-2.57). Only 21.2% of respondents correctly knew that a water-based lubricant should be used with latex condoms. CONCLUSIONS:: Male sex workers who sell sex to men in Mombasa are in acute need of targeted prevention information on anal HIV and STI transmission, consistent condom use, and correct lubrication use with latex condoms. HIV programs in Africa need to consider and develop specific prevention strategies to reach this vulnerable population.     

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.