Perceptions of HPV and attitudes towards HPV vaccination amongst men who have sex with men: A qualitative analysis

• Published in: British journal of health psychology Vol. 22; no. 2; pp. 345 - 361
• Main Authors: Nadarzynski, Tom, Smith, Helen, Richardson, Daniel, Pollard, Alex, Llewellyn, Carrie
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2017
• Subjects: Adolescent boys; Adult; Anal cancer; Anus; Attitudes; Bisexuality; Cancer; Colorectal cancer; Epidemics; Focus Groups; Gays & lesbians; Health education; Health Knowledge, Attitudes, Practice; Health services; Homosexuality; Homosexuality, Male - psychology; Homosexuality, Male - statistics & numerical data; Human papillomavirus; Humans; Immunization; Infections; LGBTQ people; Male; Men who have sex with men; Mens health; Motivation; Papillomavirus Infections - prevention & control; Papillomavirus Infections - psychology; Papillomavirus Vaccines; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Perceptions; Prejudice; Qualitative research; Risk perception; risk perceptions; Sexual and Gender Minorities - psychology; Sexual and Gender Minorities - statistics & numerical data; Sexual health; Sexual health services; Sexual orientation; Stigma; Transgender persons; United Kingdom; Uptake; Vaccination - psychology; vaccination behaviour; vaccine acceptability; Vaccines; Young Adult; vaccine acceptability; men who have sex with men; risk perceptions; vaccination behaviour; human papillomavirus
• DOI: 10.1111/bjhp.12233
• ISSN: 1359-107X; 2044-8287

Objectives Men who have sex with men (MSM) are at risk of genital warts and anal cancer due to human papillomavirus (HPV) infection. This study explores MSMs’ perceptions of HPV and HPV vaccination prior to the introduction of this programme. Design Focus groups and one‐to‐one interviews with self‐identified MSM were conducted between November 2014 and March 2015 in Brighton, UK. Methods Participants were recruited from community‐based lesbian–gay–bisexual–transgender (LGBT) venues and organizations. Discussions were recorded, transcribed verbatim, and analysed using framework analysis. Results Thirty‐three men took part (median age 25 years, IQR: 21–27), most of whom (n = 25) did not know about HPV, anal cancer (31), or HPV vaccination (26). While genital warts and anal cancer were perceived as severe, men did not perceive themselves at risk of HPV. All MSM would accept the HPV vaccine if offered by a health care professional. The challenges of accessing sexual health services or openly discussing same‐sex experiences with health care professionals were perceived as barriers to accessing HPV vaccination. Two participants were concerned that selective HPV vaccination could increase stigma and prejudice against MSM, comparable to the AIDS epidemic. Ten MSM were unsure about the effectiveness of HPV vaccination for sexually active men and were in favour of vaccinating all adolescent boys at school. Conclusions Most MSM have poor knowledge about HPV and associated anal cancer. Despite the lack of concern about HPV, most MSM expressed willingness to receive HPV vaccination. There is a need for health education about the risks of HPV and HPV‐related diseases so that MSM can appraise the benefits of being vaccinated. Concerns about HPV vaccine effectiveness in sexually active men and possible stigmatization need to be addressed to optimize HPV vaccine acceptability. Statement of contribution What is already known on this subject? Men who have sex with men (MSM) have poor knowledge about HPV and HPV‐related diseases. Perceived risk of HPV and attitudes towards HPV vaccination are associated with HPV vaccine acceptability amongst MSM in the United States. There is a gap between acceptability and uptake of HPV vaccination amongst MSM. What does this study add? Due to concerns about compromised effectiveness of the HPV vaccine in sexually active men, most MSM would recommend vaccination of all adolescent boys. Restricted access to sexual health services and the inability to discuss same‐sex experiences were perceived as barriers to HPV vaccination. While the HPV vaccine is acceptable amongst MSM, the motivation to be vaccinated and complete the three‐dose series might be low.