HPV vaccine uptake in men who have sex with men in Scotland

Human papillomavirus (HPV) vaccines are currently utilised globally in national immunisation programmes. In July 2017, a national HPV vaccine programme for men who have sex with men (MSM) was initiated across Scotland with vaccine being offered in the sexual health clinic setting. During the first year of this targeted vaccination programme, there were 5905 individuals who received at least one dose of HPV vaccine, representing 63.7% of eligible MSM attendees in this period. Vaccine uptake was relatively stable across all age groups (range 49.8–55.5%). The vaccination programme appears to have dovetailed well with pre-existing sexual health services and appears to be popular with MSM attending the service. The MSM HPV vaccine programme is a robust adjunct to the national girls programme but gender-neutral immunisation will reduce stigma and inequality in HPV-driven disease.     

Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne,Australia

The Victorian Government introduced a time-limited quadrivalent human papillomavirus (HPV) vaccination catch-up program targeting gay and bisexual men who have sex with men (MSM) aged up to 26 years in 2017. As of 2017, men aged ≥20 years were not eligible for the school-based HPV vaccination program. This study examined the prevalence of anal HPV among 496 MSM aged 20–26 years before they received the first dose of the HPV vaccine at the Melbourne Sexual Health Centre, Australia. More than half (56.5%) had any high-risk HPV genotypes detected in the anus. Almost half (43.1%) had at least one quadrivalent HPV vaccine-preventable genotype (6, 11, 16 or 18) and one-fifth (21.0%) had HPV 16 detected in the anus. These findings suggest that a targeted catch-up HPV vaccination program for MSM is still beneficial to protect against high-risk HPV genotypes associated with anal cancer, as well as low-risk HPV genotypes.     

Men having sex with men and the HPV vaccine in France: A low vaccine coverage that may be due to its infrequent proposal by physicians

IntroductionIn France, the human papilloma (HPV) vaccine is recommended to all female adolescents, and since 2016 to men having sex with men (MSM) under the age of 27. Here, we aimed to explore HPV vaccine coverage in adult MSM living in France.MethodsWe elaborated an anonymous online questionnaire targeting MSM and disseminated it between October 7, 2018 and January 15, 2019 by various means, including a Facebook® discussion forum for pre-exposure prophylaxis (PrEP) users.ResultsOverall, 2094 participants completed the questionnaire (mean age 35.4 ± 11 years); 25.8% were in the age class targeted by the HPV vaccine recommendation; 16.1% were in a PrEP program. On a 1–10 scale, they evaluated being “in favor of vaccination” at a median of 10, and general vaccine usefulness and harmfulness at medians of 10 and 2, respectively; 62.4% considered that the HPV vaccine was rather not or not at all dangerous. Those using PrEP had better perceptions of vaccination in general and of the HPV vaccine in particular. For the 1728 participants with a family physician, he/she had proposed the HPV vaccine in 9.9% of cases (9.1% of those in the targeted age class [<27 years]). Overall, 1994 knew their HPV vaccine status; 8.0% had received at least 1 dose of the vaccine, including 17.9% of those in the targeted age class (and 52.2% among the 40 participants in this age group who received PrEP). When the 1935 participants who declared to be unvaccinated against HPV were asked whether they would accept to be vaccinated, 34.4% answered “rather yes” and 45.5% “definitely yes”.ConclusionHPV vaccine coverage is low among French MSM. Our results suggest that this trend has more to do with the infrequent proposals made by clinicians than with negative vaccine perceptions.     

Sexual identities and sexual health within the Celtic nations: An exploratory study of men who have sex with men recruited through social media

ABSTRACT

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.     

Vaccine acceptability,uptake and completion amongst men who have sex with men: A systematic review,meta-analysis and theoretical framework

BackgroundDue to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.MethodsIn January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling.ResultsSeventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM).ConclusionDespite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.     

Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research

ObjectiveTo compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505.DesignRetrospective, observational study.MethodsThe University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations.ResultsOnline recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33 months), Craigslist - 12(33 months), WBMC - 11(6 months), and GRINDR - 16(0.56 months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior.ConclusionUse of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.     

Assessing knowledge of human papillomavirus among men who have sex with men (MSM) using targeted dating applications

BackgroundThe incidence of HPV-related oropharyngeal and anal cancer has been increasing significantly over the past 30 years, especially among males. This study sought to better understand the level of knowledge of HPV-related disease in the LGBTQ+ community, and serve as a method to increase awareness for HPV vaccination as a safe and effective method for cancer prevention.MethodsSCRUFF and Jack’d are geosocial networking and dating mobile applications for men who have sex with men (MSM). All users of the applications who were located in the US at the time of the study were invited to participate in a survey on HPV knowledge, the HPV vaccine, and vaccination status. The Pearson test was used to identify possible associations.ResultsHalf of the HPV vaccine-eligible respondents reported having received at least one dose of the HPV vaccine, while only 37.9% of the individuals aged 9–26 reported being vaccinated against HPV. Among the unvaccinated, 63.3% reported being interested in future vaccination, or learning more about it. No significant differences were noted regarding vaccination status nor HPV knowledge between respondents from rural vs urban locations. Respondents from the South were the least knowledgeable about cancer and genital warts caused by HPV (79.4%, p < 0.01), and had the lowest rate of vaccination compared to other regions (18.5%, p < 0.01). More than half of respondents reported being either somewhat comfortable (15.8%) or very comfortable (42.2%) with receiving the HPV vaccine from a dentist.ConclusionsThe findings of this study identify demographic groups and geographical areas where preventive campaigns for HPV would be most needed. The findings highlight dental providers as an underutilized source of HPV education and vaccine recommendation. The study reveals opportunities to close gaps in care and knowledge, and points to future directions for research and development of effective interventions.     

Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States

Gay and bisexual men are at increased risk of anal cancer as a result of human papillomavirus (HPV) infection. Prophylactic vaccination is a potentially effective strategy for preventing anal cancer in this population. The purpose of this study was to identify factors associated with gay and bisexual men's intention to receive HPV vaccine. In the fall of 2010, 179 self-identified gay and bisexual men (mean age 22 years) completed an Internet-based questionnaire assessing beliefs and attitudes toward HPV vaccination. Men were recruited from college-based and Internet venues throughout the southeastern United States. The probability of intent to receive HPV vaccine was modeled using logistic regression. A majority of men (93%) had heard of HPV prior to participation but were generally unaware of the association of HPV with anal, penile, and oral cancers. Only 26% were aware of an HPV vaccine for males. Of the 179 participants, 64 (36%) were likely to be vaccinated. Men most likely to receive HPV vaccine perceived stronger physical and psychological benefits from vaccination and had more positive attitudes toward the vaccine. Conversely, intent to be vaccinated was negatively associated with concern over the financial cost of vaccination. Findings from this study can inform college-based health education programs aimed at increasing vaccine uptake among gay and bisexual men.     

Willingness to participate in HIV vaccine clinical trials among Chinese men who have sex with men

HIV vaccine trials require volunteers. Little is known about willingness to participate (WTP) in HIV vaccine trials among Chinese MSM. A survey of 550 MSM was conducted from March to June 2008, in Beijing, China. Data were collected on demographics, behaviors, perceptions about HIV/AIDS and HIV vaccines, and concerns about participation in HIV vaccine clinical trials. Of study participants, 35.8% were definitely willing to participate, 35.1% were probably willing, 16.4% were probably not willing, and 12.7% were definitely not willing. Analyses suggest that perceived family support, perceived protection against HIV infection and fear that participation would result in social distancing were associated with WTP. MSM in China may be good candidates for HIV vaccine trials. Further studies are needed to evaluate actual enrollment.     

Men who have sex with men inadequately addressed in African AIDS National Strategic Plans

Abstract

Through an analysis of AIDS National Strategic Plans (NSPs), this study investigated the responses of African governments to the HIV epidemics faced by men who have sex with men (MSM). NSPs from 46 African countries were systematically analysed, with attention focused on (1) the representation of MSM and their HIV risk, (2) the inclusion of epidemiologic information on the HIV epidemic among MSM and (3) government-led interventions addressing MSM. Out of 46 NSPs, 34 mentioned MSM. While two-thirds of these NSPs acknowledged the vulnerability of MSM to HIV infection, fewer than half acknowledged the role of stigma or criminalisation. Four NSPs showed estimated HIV prevalence among MSM, and one included incidence. Two-thirds of the NSPs proposed government-led HIV interventions that address MSM. Those that did plan to intervene planned to do so through policy interventions, social interventions, HIV-prevention interventions, HIV-treatment interventions and monitoring activities. Overall, the governments of the countries included in the study exhibited little knowledge of HIV disease dynamics among MSM and little knowledge of the social dynamics behind MSM's HIV risk. Concerted action is needed to integrate MSM into NSPs and governmental health policies in a way that acknowledges this population and its specific HIV/AIDS-related needs.     

Oral and oropharyngeal high-risk HPV prevalence,HIV status,and risk behaviours in a cohort of South African men who have sex with men

Data lag is evident when observing studies focussing on human papillomavirus (HPV) prevalence in the head and neck of men who have sex with men (MSM) in Southern Africa. Sexual behaviours other than anal intercourse, and associated factors are similarly underreported. HPV vaccination has not yet commenced for this population group. One hundred and ninety-nine MSM were enrolled in this study. Participants completed a questionnaire followed by a clinical oral examination, and a rinse-and-gargle specimen in Thinprep^® vials containing Preservcyt^® solution was collected. Detection and genotyping for high-risk HPV were done by an automated system (Abbott^® m2000sp). Six percent of MSM in this cohort had high-risk HPV present in the mouth/oropharynx. This cohort averages 29 years of age, more than half were unemployed (53.3%), and 66.8% were human immunodeficiency virus (HIV) seropositive. The most common sexual practice was anal sex (69.4%) followed by oral sex (28.6%), and by rimming (9.6%). A significant association between oral insertive sex and oral/oropharyngeal HPV status was demonstrated (p = 0.0038; phi coefficient = 0.20). An incidental but significant association between rimming and HIV status was found (p = 0.0046; phi coefficient = 0.19), and HIV seropositive participants had higher oral/oropharyngeal HPV presence. The HPV prevalence of 6% reported in this study is in alignment with global reports. The prevalence of oral/oropharyngeal HPV in this MSM cohort was influenced by sexual practices. MSM participants who practiced rimming appear to be at higher risk of HIV acquisition. Given the transmission routes of HPV in this vulnerable population, vaccination must be urgently studied as an intervention for prevention.     

Acceptability of HPV vaccines and perceptions related to genital warts and penile/anal cancers among men who have sex with men in Hong Kong

Men who have sex with men (MSM) are at high risk of contracting HIV and developing genital warts and penile/anal cancers. HPV vaccines are efficacious in preventing such HPV-related diseases among males and WHO recommends its use to young MSM. In a cross-sectional survey, 542 MSM were interviewed. After being briefed about the vaccines’ efficacies and the market price, the prevalence of acceptability of HPV vaccination was 29.2%. Adjusted by significant background variables, perceived high/very high chances of contracting genital warts [adjusted odds ratio (AOR) = 2.04, 95%CI = 1.11–3.72] and penile/anal cancers (AOR = 1.89, 95%CI = 1.09–3.29) among local MSM, perceived moderately high mortality rate of penile/anal cancers (AOR = 1.78, 95%CI = 1.13–2.81), fear toward penile/anal cancers (moderate: AOR = 1.75, 95%CI = 1.07–2.86; high/very high: AOR = 1.82, 95%CI = 1.13–2.92) and disagreement with the statement “MSM in general are not willing to take HPV vaccines” (AOR = 1.82, 95%CI = 1.24–2.68) were associated with the conditional acceptability. Acceptability of this new measure is reasonably high and there are rooms for improvement. Implementation trials to promote HPV vaccination by changing cognitions such as HPV-related risk perceptions, norms and perceptions toward anal/penile cancer are greatly warranted.     

昆明市男男性接触者不同场所活动人群危险性行为状况分析

目的评估不同活动场所中男男性接触人群安全性行为状况、干预工作的成效及确定干预工作的重点。方法以面对面访问的方式对昆明市经常到公园、酒吧、浴室以及通过志愿者网络对较少到公共场所活动的男男性接触者进行艾滋病相关行为监测调查。结果4类被调查人群中6个月内肛交性伴情况为：浴室人群的性伴人数最多,2005年中位数是4.33,2006年是3.95;其次为公园人群,2005年是2.74,2006年是3.55。酒吧人群的性伴人数最少,2005年是2.52,2006年是1.70。男男性接触人群6个月内安全套使用率2005年为44.9%,2006年为51.1%。结论经常到浴室、公园以及较少到公共场所活动的男男性接触者具有较多的性伴和较高的性行为频度,是值得关注的人群。安全套使用虽有逐年上升的趋势,但仍较低,应分人群对安全套使用影响因素进行研究,以制定更加有效的干预策略。     

HlV/STD risks in young men who have sex with men who do not disclose their sexual orientation--six U.S. cities, 1994-2000

To avoid social isolation, discrimination, or verbal or physical abuse, many men who have sex with men (MSM), especially young and minority MSM, do not disclose their sexual orientation. Young MSM who do not disclose their sexual orientation (nondisclosers) are thought to be at particularly high risk for human immunodeficiency virus (HIV) infection because of low self-esteem, depression, or lack of peer support and prevention services that are available to MSM who are more open about their sexuality (disclosers). However, the risks for HIV infection and other sexually transmitted diseases (STDs) are unknown for nondisclosers. To better understand the prevention needs of young MSM, CDC analyzed data from the Young Men's Survey (YMS) to compare HIV/STD risk differences between nondisclosers and disclosers. This report summarizes the results of that analysis, which indicate that 8% of 637 nondisclosers were infected with HIV compared with 11% of 4,952 disclosers. Among blacks, the prevalence of HJV infection was 14% among 199 nondisclosers compared with 24% among 910 disclosers.     

Perceptions of sexual violence among men who have sex with men and individuals on the trans-feminine spectrum in Mongolia

With the growing realisation that sexual violence poses pressing health and human rights concerns for men who have sex with men (MSM) and individuals on the trans-feminine spectrum, research has focused on the context in which sexual violence takes place. Rape myths and other perceptions of sexual violence affect the prevalence of perpetration and the availability of services and support for survivors. Little research has been conducted on rape myths among sexual and gender minority groups, especially in low- and middle-income countries. Two focus groups and 30 in-depth interviews were conducted with MSM and individuals on the trans-feminine spectrum in Ulaanbaatar, Mongolia. A number of rape myths previously noted to be prevalent among Western, heterosexual men, and women were expressed by participants, including the myth that males are never raped, rape as a cause of homosexuality or transgenderism, conceptualisations of prototypical rape as requiring overwhelming force, and victim blaming. However, many of these perceptions appeared to have different origins and effects in these populations. This study illustrates interesting similarities and differences compared to rape myths explored in Western, heterosexual male samples, and draws attention to the need to address community perceptions of sexual violence in sexual health and violence intervention programming.     

Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City

The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual and heterosexual-identifying men who have sex with men and male-to-female transgender persons in Guatemala City, to inform the development of high quality and population-friendly services. In-depth, semi-structured interviews were conducted with 29 purposively sampled individuals, including 8 transgender, 16 gay/bisexual and 5 heterosexual-identifying participants. Topical codes were applied to the data using software Atlas.ti? to compare data between sub-groups. Analysis revealed that public clinics were most commonly used due to their lower cost and greater accessibility, but many participants experienced discrimination, violation of confidentiality and distrust of these services. Transgender and gay/bisexual-identifying participants preferred clinics where they felt a sense of belonging, while heterosexual-identifying participants preferred clinics unassociated with the men who have sex with men community. The most prominent barriers to sexual health services included fear of discrimination, fear of having HIV, cost and lack of social support. Findings highlight the need to strengthen existing public sexually transmitted infection clinics so that they address the multiple layers of stigma and discrimination that men who have sex with men and transgender persons experience.     

重庆地区男男性行为人群多性伴行为特征及影响因素

目的  了解重庆地区艾滋病病毒(human immunodeficiency virus, HIV)阴性多性伴肛交(≥5人)男男性行为者(men who have sex with men, MSM)的人口学和性行为特征及其影响因素。 方法  从2018年6月至2019年6月, 招募重庆地区319名HIV阴性MSM, 收集其人口学特征、近半年内安全套使用率、是否感染性病、性角色、药物滥用史、是否服用过暴露后预防(post-exposure prophylaxis, PEP)药物、是否关注HIV知识和是否服用过暴露前预防(pre-exposure prophylaxis, PrEP)药物等信息。采用单因素和多因素Logistic回归分析模型分析MSM人群多性伴肛交的影响因素。 结果  319名HIV阴性MSM中, 34.5%(110/319)近6个月内性伴人数≥5人; 110名多性伴MSM中, 63.6%(70/110)年龄≤28岁, 75.4%(83/110)学历为大学本科或大专; 50名报告情感状况的MSM中, 72.0%(36/50)为单身。多因素Logistic回归分析模型分析显示, 服用过PEP药物和经常关注HIV知识是MSM多性伴肛交的主要影响因素。 结论  重庆地区HIV阴性MSM人群普遍存在多性伴肛交现象。应加大对MSM人群, 尤其是低龄MSM人群, HIV防治知识的宣教力度。在推广PrEP和PEP在MSM人群中的使用时, 应警惕其相关风险补偿。     

捕获-标记-再捕获法在男男性行为人群规模估计中的应用

[目的] 估计上海市男男性行为者(MSM)人群规模。[方法] 采用捕获-标记-再捕获法对MSM人群进行人群规模的基数估计。通过网络调查,获取捕获-标记-再捕获法的重要参数。用滚雪球的方法招募现场调查对象,并对调查对象开展进行面对面问卷调查。[结果] 捕获-标记-再捕获法估计出上海市MSM人群规模的基数为86 883人(36 260人至137 506人)。[结论] 本市基于MSM网站和现场调查的捕获-标记-再捕获法的MSM人群规模估计方法,能满足方法的应用条件,可信度较高。     

Immunity to hepatitis A when outbreaks of infection in men who have sex with men (MSM) are rare

Background

Epidemics of hepatitis A among men who have sex with men (MSM) have decreased significantly in recent years although the level of immunity that is required to prevent epidemics has not been studied. Our aim was to determine the level of immunity to hepatitis A among MSM.

Methods

This was a retrospective study conducted using notifications of Hepatitis A in Victoria from 1991 to 2010, serological testing for hepatitis A among MSM attending Melbourne Sexual Health Centre (MSHC), and vaccination records among MSM attending MSHC.

Results

Hepatitis A notifications declined from 370 to 47 and the male to female ratio declined from 4.2 to 0.9 in Victoria between1991 to 2010. Between 2002 and 2011, there were 12,064 individuals MSM seen at MSHC of whom 3055 (25%) were tested for hepatitis A antibodies and 1180 (39%) had antibodies. The proportion of MSM who were tested for hepatitis A rose significantly over time (P < 0.01), but the proportion of these with hepatitis A antibodies did not (P = 0.28). Hepatitis A antibodies were more common in MSM over 30 (54%) compared to those 30 or less (32%), (Crude Odds Ratio 2.5 (95% confidence interval 2.1–2.9)) and were uncommon in MSM under 20 (19%). Vaccination against hepatitis A was recorded in 49% of 660 clinical files of MSM who attended the centre between 2003 and 2011 and did not change over time (P = 0.42) but was significantly more common in those over 30 years of age (P < 0.005).

Conclusion

Hepatitis A is rare in MSM in Victoria where levels of immunity are about 40–50%. As outbreaks have occurred when levels of immunity were around 30%, maintaining vaccination levels over 40–50% is important if outbreaks are to be prevented. The lower levels of immunity in younger MSM create the potential for outbreaks in this sub-group.