Human Papillomavirus Vaccination Among Straight, Gay, and Bisexual Men in the United States

Background and Purpose: Gay and bisexual men (GBM) are disproportionally affected by sexually transmitted diseases (STDs) including the most common such infection, Human Papillomavirus (HPV). HPV vaccination is an effective and safe way to prevent HPV infection. Moreover, given the high rate of co-occurrence between HPV and HIV, it is especially recommended GBM at increased risk for HIV infection get an HPV vaccination. Thus, HIV testing represents an opportunity to promote HPV vaccination for people at high risk for HIV. Understanding how sexual orientation and HIV testing are associated with HPV vaccination is potentially important for increasing HPV vaccination uptake among GBM. This study aimed to address two main questions: 1) Do HPV vaccination initiation and completion vary by sexual orientation among adult men? 2) Does sexual orientation moderate the relationship between HIV testing and HPV vaccination initiation and completion among adult men?

Methods: We used combined data from the 2014-2018 U.S. Behavioral Risk Factor Surveillance System (BRFSS). A total of 15,905 men aged 18-44 years old who completed questions on HPV vaccination. Participant sexual orientation was categorized as straight, gay, and bisexual was the primary independent variable. The primary dependent variables were HPV vaccination initiation, defined as ever having had at least one HPV vaccination shot and completion, defined as receiving the recommended three-dose series of shots. We estimated binary logistic regression models to examine sexual orientation and HPV vaccination initiation and completion, adjusting for demographics, ever tested for HIV, health conditions, substance use, and health care access. Multiple imputation was used to reduce missing data on model predictors.

Results: Only 7.9% of all men had initiated HPV vaccination and only 31.2% of the initiators completed the full vaccination schedule. Gay (aOR=1.49, p<.01) and bisexual (aOR=1.83, p<.001) men were more likely to initiate HPV vaccination than straight men. However, there was no difference in HPV vaccination completion between GBM and straight men. Men who had ever been tested for HIV were more likely to initiate (aOR=2.18, p<.001) and complete an HPV vaccination (aOR=1.54, p<.05). Sexual orientation moderated the relationship between HIV testing and HPV vaccination completion but not between HIV testing and HPV vaccination initiation. Bisexual men who had been tested for HIV were more likely to complete the vaccination (aOR=8.08, p<.001) while gay men who had HIV testing were less likely to complete (aOR=0.23, p<.05).

Conclusions and Implications: We found significant differences in HPV vaccination initiation and completion by sexual orientation. Although GBM had a higher HPV vaccination initiation rate than heterosexual men, it was still suboptimal given HPV vaccination is highly recommended for sexually active GBM. Additionally concerning is that many GBM initiators did not complete the vaccination schedule. Social workers seeing sexual minority men should emphasize HPV vaccinations along with HIV testing and provide their GBM clients with ongoing encouragement to complete the full three-shot course. This is especially important for gay men who have already had HIV testing, the group least likely to complete HPV vaccinations after initiation.