Gay men likely to be highly sexually experienced before they are willing to 'come out' to obtain HPV vaccine

Gay men will have a high level of sexual experience before they are willing to disclose their sexuality to healthcare providers so they can obtain a vaccine for human papilloma virus, an Australian study published in the online edition of Sexually Transmitted Infections has shown. This could mean that many gay men would already have been infected with human papilloma virus (HPV) before they were willing to come forward for vaccination, meaning that its protective effect for these individuals would, at best, be extremely limited.

Earlier research has suggested that there is a high prevalence of genital and anal infection with human papilloma virus amongst gay men, with particularly high levels of infection seen amongst gay men with HIV. Infection with human papilloma virus increases the risk of anal cancer, which occurs with greater frequency in gay men, most notably HIV-positive gay men.

Two vaccines that offer a high level of protection against the strains of human papilloma virus most associated with cervical (and anal) cancer have recently been approved. Their use is currently restricted to women, and to ensure that they have the maximum possible protective effect, UK guidelines state that they should be given to girls aged between twelve and 13 before they become sexually active.

Studies are currently evaluating the safety and effectiveness of these vaccines in men (and people with HIV).

Researchers in Melbourne, Australia, wanted to see how acceptable gay men would find a vaccine for human papilloma virus (assuming the results of trials were favourable). Furthermore, they wanted to gain an impression of how useful the vaccine would be at preventing infection with human papilloma virus.

They therefore collected information about the age at which gay men would feel comfortable disclosing their sexuality to a healthcare worker if this was a requirement to obtain the vaccination for free; the age at which they became sexually active; and the number of sexual partners they had had in the interval between their sexual debut and the age at which they would have been willing to come forward as an “out” gay man to obtain a vaccine.

The study had a cross-sectional (snap-shot) design and included 200 gay men who attended a sexual health clinic in Melbourne in November and December 2007. The men had a median age of 27 (range, 19-71).

The men were told that a vaccine was available against certain types of human papilloma virus and they were asked to assume that it would prevent most cases of anal and genital warts and 80% of anal cancer cases. They were told that the cost of the vaccination would be Australian $450 (approximately £220).

The men were then asked:

• Would they be prepared to pay for the vaccine in these circumstances?
• If the vaccine were free, would they be prepared to tell a healthcare provider that they were gay in order to obtain it?
• At what age would they be comfortable telling a healthcare provider they were gay to obtain this vaccine?
• The age at which they first engaged in a number of sexual activities with another man, such as insertive and receptive oral sex; insertive and receptive anal sex; and insertive and receptive fingering (digital-anal contact).

Almost three-quarters (74%) of men had heard of the “wart virus” or HPV. Only 30% reported having heard of a vaccine against the virus, although a further 54% of the men said they were unsure. Fewer than half the men (47%) said that they would be willing to pay for the vaccine.

However, 93% of the men told the investigators that they would be willing to tell a healthcare provider that they were gay in order to obtain this vaccine. The median age that the men said they would be comfortable telling a healthcare provider that they were gay was 20 (range, 12-60 years).

But by this age the men were already sexually experienced. The median age that the men first had oral sex (insertive and receptive) was 18 years, and the median age for first insertive and receptive anal sex was 20 years. The age at which men first reported fingering or contact between the penis and anus varied between 18 and 20 years.

The researchers found that the men had had a median of 15 (range, 0-2500) male sexual partners between the age of sexual debut and the age of 20. Furthermore, fewer than a third (31%) of men said that they had first had receptive anal sex after the age at which they would have been willing to disclose their sexuality to a healthcare worker.

“Almost all men said they would be prepared to disclose their sexuality to a health professional in order to obtain the [human papilloma virus] vaccine free of charge” comment the investigators. They add, “however, the age at which they would have been willing to do this was on average two years after their sexual debut and after a median of 15 sexual partners”.

The investigators therefore express concern that “the probability of prior exposure to genital HPV infection would be high”.

They believe that their findings raise a “dilemma” for policy makers – “whether to provide the vaccine to all boys in order to reduce the risk of anal cancer in men who have sex with men”.