How can we better respond to HPV-related diseases? A summary of findings from the Engage study.

Provincial programs to vaccinate gay, bisexual, and queer (GBQ) men against human papillomavirus (HPV) are working, but gaps in access mean many are left unprotected against HPV-related diseases.

For GBQ men—who experience a greater risk of HPV-related diseases like cancers and genital warts—only those under 27 are eligible for free vaccination. 

New research from a study in Montreal, Toronto, and Vancouver found that 26 to 35 percent of guys under 27 had gotten at least one shot.[i] By comparison, only 7 to 26 percent of guys aged 27 years and older had done the same. Concerningly, a large number of guys were not aware that the HPV vaccine exists or that it’s specifically recommended for men who has sex with men.

“I was surprised at how many men were not aware of the HPV vaccine at all,” says Dr. Ramandip Grewal, who led this research as part of her PhD at the University of Toronto. She found that cost was a key barrier among older guys ineligible for free vaccine.

“We too often place the responsibility on the individual and ignore the larger systemic barriers to vaccination,” she says. “Instead, we need to work alongside the community and tailor interventions so that we can effectively reach the men being missed for HPV vaccination.”  

In addition to vaccine coverage, one way to tailor interventions and reduce barriers is to make use of existing sexual health services such as STI/HIV testing and PrEP. Bundling HPV vaccination with these types of services and making men feel more comfortable disclosing their sexual orientation in healthcare settings could help improve uptake.[ii]

These findings come from the Engage study, which followed almost 2,500 sexually-active GBQ men aged 16 years and older in Vancouver, Toronto and Montreal.

Encouragingly, when researchers followed up with guys in the study, they found that 30 percent of unvaccinated guys eligible for free HPV vaccine had gotten a dose one year later.[iii] But again, they found that this was much lower (around 6 percent) among older guys, who weren’t eligible for free vaccination.

Next, researchers looked at anal HPV infections in young men aged 30 and younger at their enrolment visit.[iv] They found that vaccinated guys were less likely to be infected with types of HPV that could be prevented by vaccination compared to unvaccinated men. They also found that the vaccine was most effective in those who got vaccinated at younger ages or soon after they started having sex for the first time.

“These findings support our current public health guidelines, which recommend that guys who identify as gay or bisexual get vaccinated against HPV, preferably at younger ages before they’ve had a lot of sexual partners,” says Catharine Chambers, a PhD candidate at the University of Toronto who led this part of the study. 

GBQ men are at higher risk for HPV-associated diseases like anal cancer or warts compared to the general population. For this reason, public health experts advise that men get vaccinated with the HPV vaccine. Most people will acquire at least one HPV infection within a few years of becoming sexually active. Two to three doses are needed to be fully protected depending on how old you are when you get your first shot. 

“Research findings like these inform how we can best prevent HPV-associated diseases among gay and bisexual men in real-life settings” said Dr. Ann Burchell, Associate Professor, Department of Family and Community Medicine, University of Toronto, and Principal Investigator of the HPV studies being conducted within Engage. “Our ongoing studies with Engage will investigate further the degree of protection that HPV vaccination provides against chronic anal and oral infections among men across the lifespan. Vaccination combined with cancer screening, when broadly accessible, is likely our best shot at preventing anal and oral cancers in the long term.”

[i] Grewal R, Deeks SL, Hart TA, et al. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine. 2021 Jun 23;39(28):3756-3766.

[ii] Grewal R, Deeks SL, Hart TA, et al. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada’s three largest cities. Hum Vaccin Immunother. 2021 Dec 2;17(12):5413-5425.

[iii] Chambers C, Deeks SL, Sutradhar R, et al. Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada. Vaccine. 2022 Jun 9;40(26):3690-3700.

[iv] Chambers C, Deeks SL, Sutradhar R, et al. Anal human papillomavirus prevalence among vaccinated and unvaccinated gay, bisexual, and other men who have sex with men in Canada. Sex Transm Dis. 2022 Feb 1;49(2):123-132. doi: 10.1097/OLQ.0000000000001560

November 14th, 2022