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. Author manuscript; available in PMC: 2023 Dec 1.
Published in final edited form as: Sex Res Social Policy. 2022 Jun 8;19(4):1944–1953. doi: 10.1007/s13178-022-00740-9

Uptake of Human Papillomavirus Vaccination by HIV Status and HIV Pre-exposure Prophylaxis (PrEP) Care Engagement Among Young Sexual Minority Men 17–24 Years Old in the USA

Benedikt Pleuhs 1, Jennifer L Walsh 1, Katherine G Quinn 1, Andrew E Petroll 1, Alan Nyitray 1,2, Steven A John 1,§
PMCID: PMC9857745  NIHMSID: NIHMS1815791  PMID: 36687804

Abstract

Introduction:

HIV and human papillomavirus (HPV) are common sexually transmitted infections among young sexual minority men (YSMM) that are prevented by pre-exposure prophylaxis (PrEP) and HPV vaccination, respectively. We sought to determine the association between a history of PrEP use and HPV vaccination uptake among YSMM.

Methods:

Data were collected from an online survey of YSMM (n = 287; Mage = 20.6 years, range: 17–24; 58% Black or Latinx) recruited from social media and men-for-men geosocial networking apps in 2020 and analyses were conducted using chi-squared comparisons and Poisson regression using STATA (IC) version 15.1.

Results:

About half (45.0%) of YSMM reported receiving at least one dose of the HPV vaccine. Controlling for other factors, YSMM who were living with HIV or had used PrEP were significantly more likely to have received at least one dose of an HPV vaccine (PR = 2.48, 95% CI = 1.52–4.07; PR = 1.70, 95% CI = 1.26–2.31, respectively).

Conclusions:

YSMM living with HIV or with PrEP use experience reported higher rates of HPV vaccination compared to their counterparts, potentially due to greater utilization of health care or contacts with providers attuned to their health needs. Nevertheless, HPV vaccination uptake is suboptimal given the high prevalence of high-risk HPV genotypes among YSMM.

Policy Implications:

Standard of care for YSMM should include revisiting HPV vaccination status and discussion of PrEP and other HIV prevention methods given suboptimal rates of HPV and PrEP uptake among this priority population for HPV vaccination, anal cancer, and HIV prevention.

Keywords: HIV, pre-exposure prophylaxis, HPV, vaccination, sexual minority men, men who have sex with men

INTRODUCTION

Sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, are disproportionately affected by HIV and preventable infections such as human papillomavirus (HPV) (Kim, 2010; Markowitz et al., 2014; Meites, Markowitz, Paz-Bailey, & Oster, 2014; Pitasi, Bingham, Sey, Smith, & Teshale, 2014; Rudy, Detels, Douglas, & Greenland, 2003). HPV is particularly concerning due to high-risk HPV genotypes that increase risk for anal cancer, of which there were 2690 new diagnoses and 540 deaths in 2020 (American Cancer Society, 2020). Risk for HPV is even higher for people living with HIV, with a collaborative pooled analysis of 64 studies showing a significantly increased HPV prevalence among individuals living with HIV (Wei et al., 2021). Although annual incidence of anal cancer is very low overall in the population (1–2/100,000), the risk of anal cancer is much higher among HIV-negative SMM (19/100,000) and especially SMM living with HIV (85/100,000). In comparison, the annual incidence of HPV-associated cervical cancer in the U.S. was approximately 7/100,000 from 2013–2017 (Centers for Disease Control and Prevention (CDC), 2020a; Wei et al., 2021).

Since 2016, Gardasil 9 is the only vaccine distributed in the U.S. providing protection against high-risk HPV types 16, 18, 31, 33, 45, 52 and 58, which are known to cause cervical cancer; the vaccine has demonstrated efficacy against anal high-grade squamous intraepithelial lesions, which is considered the precursor to anal cancer (Dillner et al., 2010; Group, 2007; Meites et al., 2020; Nadarzynski et al., 2021; Paavonen et al., 2009; Palefsky et al., 2011; Palefsky et al., 2021; Winer et al., 2021). Additionally, studies have shown that HPV vaccination is also very effective in preventing HPV infection among SMM (Giuliano et al., 2011). For these reasons, an Advisory Committee on Immunization Practices changed their recommendations in 2011 to support HPV vaccination of all males age 11 or 12 years old through age 21 if they have not been previously vaccinated. The advisory committee also recommended HPV vaccination through age 26 years for all SMM and immunocompromised individuals, including individuals living with HIV (CDC, 2011; Markowitz et al., 2014). Clinicians are also recommended to consider HPV vaccination among adults age 27 through 45 based on individual risk factors (Meites et al., 2019).

SMM are disproportionately affected by HIV in the U.S., with approximately 69% of the 38,000 new diagnoses in 2018 occuring among SMM (CDC, 2021b). However, the introduction of HIV pre-exposure prophylaxis (PrEP) has shown significant promise in reducing HIV incidence (Baeten et al., 2012; Choopanya et al., 2013; Grant et al., 2010; Marrazzo et al., 2015; Thigpen et al., 2012; Van Damme et al., 2012). PrEP was first approved for use by the U.S. Food and Drug Administration (USFDA) in 2012 (USFDA, 2012b), with supporting clinical guidelines issued by the CDC in 2014, 2017, and 2021 (CDC, 2014b, 2017, 2021c). Nonetheless, PrEP uptake among SMM remains low, with 20% or fewer potential PrEP candidates currently taking PrEP (AVAC, 2019; John, Rendina, Starks, Grov, & Parsons, 2019; John, Robles, Starks, & Rendina, 2019).

While HPV vaccination and HIV prevention strategies have been shown to significantly reduce the incidence of anal precancers and HIV respectively, there is little research investigating HPV vaccine uptake in the context of PrEP use among young SMM (YSMM) 17 to 24 years old—a priority age group for HIV and HPV prevention. Prior research has shown PrEP to increase connection to the healthcare system, resulting in higher rates of other preventative interventions including flu vaccination (Marcus et al., 2018). SMM living with HIV and regularly engaged in care likely also have greater access to preventive care (Fisher, Cahill, Tseng, & Robinson, 2016). Therefore, drawing on data from a national online sample of YSMM, we hypothesized that those with a history of PrEP care or living with HIV would be more likely to report HPV vaccination compared to HIV-negative/unknown YSMM not on PrEP. We also hypothesized YSMM without insurance and Black and Latinx YSMM would report lower HPV vaccination rates given substantial structural barriers to health care engagement (Apaydin et al., 2018; Daniel-Ulloa, Gilbert, & Parker, 2016; Gerend, Madkins, Phillips, & Mustanski, 2016; Holman et al., 2014). Furthermore, weo explored HPV vaccination rates by age, gender identity, sexual identity, relationship status, and recruitment venue.

METHODS

Study Procedures

As described previously (Hong et al., 2021; Zapata et al., 2021), participants were recruited from social media and men-for-men geosocial networking apps between March and September 2020. Facebook and Instagram were used for recruitment on social media, and Jack’d was the primary networking app used for recruitment. Several participants were also referred from another study’s advertisements posted on Grindr. Volunteers were asked to participate in a brief, 5–10-minute screening survey as part of a recruitment campaign for a paid research study, which was recruiting YSMM to participate in online focus groups studying barriers and facilitators to HIV self-testing and PrEP. Primary recruitment images featured two men, with young couples of various race/ethnicities across images designed to oversample Black and Latinx YSMM. To be eligible for this analysis, participants were required to: (1) identify as a man (including transgender men): (2) be 17 to 24 years old; (3) identify as either gay, bisexual, queer, or another sexual minority identity; and (4) live in the U.S. The 17–24 age range was targeted because of the parent study’s goals around HIV self-testing among YSMM—given that at-home tests are only currently approved for use among individuals 17 and older—and because sexual minority men under age 25 account for the majority of HIV incidence in the U.S. (CDC, 2014a; USFDA, 2012a). Fraudulent responses were minimized by excluding any information on eligibility criteria from study advertisements and referral mechanisms (relevant within the context of the parent, paid research study recruitment campaign), using the “prevent ballot box stuffing” feature in Qualtrics to prevent multiple responses, offering no incentive for completion of the screening survey, and using a delayed invitation procedure for the parent study to avoid attempts at determining the study’s eligibility criteria (Teitcher et al., 2015). To further ensure data integrity, duplicates were checked using a procedure of comparing contact information (i.e., name, email, phone number) and IP addresses. Due to the low-risk nature of the survey, the Institutional Review Board approved a modified consent process whereby participants read an informational letter and agreed to participate. A waiver of guardian permission was obtained for those considered minors. All study procedures were approved by the Institutional Review Board of the Medical College of Wisconsin.

Measures

Sociodemographic characteristics.

Participants were asked to report their age in years. Gender identity was assessed using two questions: “What is your current gender identity?” and “Do you identify as transgender?” Only individuals who identified as male were eligible for this analysis, and only individuals who identified as transgender were coded as transgender men, regardless of sex assigned at birth. To assess sexual orientation, participants were asked “What do you consider your sexual orientation?” with response categories including (1) bisexual, (2) gay, (3) lesbian, (4) queer, (5) straight/heterosexual, and (6) another orientation (please specify). Participants were also asked to report their race/ethnicity with the following question: “Which of the following best describes your race/ethnicity” with response categories including (1) Asian or Pacific Islander, (2) Black or African American or Afro Caribbean, (3) Hispanic or Latino/Latinx, (4) Native American or Alaskan Native, (5) white, and (6) another category(s) (please specify) using select all that apply. Individuals were then coded into non-Hispanic Black, Latinx or Hispanic, non-Hispanic white, and multiracial/another categories. Participants were also identified by recruitment source and answered questions about their current insurance status with the following question: “Do you currently have medical insurance? with response options including (1) no, I am currently uninsured; (2–5) yes, a private insurance plan… [e.g., through my employer]; and (6) yes, a public insurance plan such as Medicaid.

PrEP use and HIV status.

Participants were asked questions regarding HIV status and PrEP use. Specifically, HIV status was ascertained by asking “What is your HIV status?” Responses were (1) Negative, (2) Positive, or (3) I don’t know. PrEP use was ascertained by the question: “Have you ever been prescribed HIV medications (e.g., Truvada) for use as PrEP (pre-exposure prophylaxis)?” (John, Robles, et al., 2019). Response options were (1) Yes, I am currently on PrEP; (2) Yes, but I am no longer taking PrEP; and (3) No, I’ve never taken PrEP. These two variables were then combined into a single variable with responses coded as (1) living with HIV, (2) prescribed PrEP/previously been on PrEP, or (3) HIV-negative/unknown, never on PrEP.

HPV vaccination uptake.

Participants were asked “Have you received ≥ 1 dose of Human Papillomavirus (HPV) vaccine (for example, Gardasil)?” Responses included (1) Yes, (2) No, and (3) I don’t know.

Data Analysis

Descriptive statistics were reported using frequency measures. Bivariate analyses were conducted using chi-squared comparisons and Poisson regression with a robust estimator for categorical and continuous variables, respectively, to examine if HPV vaccine uptake was associated with PrEP use and any specific demographic characteristics. Predictors were then combined in a multivariable Poisson regression with a log link function. We report adjusted prevalence ratios with 95% confidence intervals. All data analysis was conducted using STATA (IC) version 15.1.

RESULTS

Participant Characteristics

Two-hundred eighty-seven YSMM were eligible for analysis; there was no missing data in our sample of eligible respondents. Average age of respondents was 20.6 years old (SD = 2.5). A majority (61.0%) identified as gay, 33.5% identified as bisexual, 3.8% as queer, and 1.7% as another sexual identity (i.e., pansexual or asexual). Additionally, 15.3% identified as transgender, and 60.3% were currently single. The sample was racially/ethnically diverse, with 37.3% identifying as Black or African American, 20.9% Latinx or Hispanic, 31.7% as white, and 10.1% as multiracial or another race (i.e., Asian or Pacific Islander and write-in responses). Of the 287 participants, 25 (8.7%) indicated that they were currently living with HIV, 49 (17.1%) were currently or previously on PrEP, and 213 (74.2%) were HIV-negative or unknown status and never on PrEP.

A majority (53.7%) of the sample indicated that they were currently insured through private insurance. Eighty-seven (30.3%) indicated that they were currently insured through public insurance, and 46 (16.0%) were currently uninsured. Two-thirds of participants (n = 191, 66.6%) were recruited through social media, with the rest recruited from men-for-men geosocial networking apps. Finally, 45.0% of participants stated that they had received at least one dose of the HPV vaccine, while 55.1% stated that they did not know or had not received at least one dose. See Table 1 for a full description of sample characteristics.

Table 1.

Demographic characteristics, HIV-status and pre-exposure prophylaxis use (PrEP), and human papillomavirus (HPV) vaccination among young sexual minority men recruited online (N = 287)

Categorical Variables n %
Gender Identity
 Cisgender man 243 84.7
 Transgender man 44 15.3
Relationship Status
 Single 173 60.3
 In relationship 114 39.7
Sexual Orientation
 Gay 175 61.0
 Bisexual 96 33.5
 Queer 11 3.8
 Another ‡ 5 1.7
Race/ethnicity
 Black, non-Hispanic 107 37.3
 Latinx or Hispanic 60 20.9
 White, non-Hispanic 91 31.7
 Multiracial/another† 29 10.1
Recruitment Source
 Social media 191 66.6
 Men-for-men geosocial networking app 96 33.5
Insurance Status
 Currently insured through private insurance 154 53.7
 Currently insured through public insurance 87 30.3
 Currently uninsured 46 16.0
HIV Status and PrEP Use
 Living with HIV 25 8.7
 Prescribed PrEP/previously on PrEP (HIV-negative) 49 17.1
 HIV-negative/unknown, never on PrEP 213 74.2
Received ≥ 1 dose of HPV vaccine
 Yes 129 45.0
 No/I don’t know 158 55.1
Continuous Variable M SD
Age (Range: 17–24) 20.6 2.5
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Note: Percentages may not add up to 100 due to rounding.

‡

Another sexual orientation included pansexual (n = 4) and asexual (n = 1).

†

Another race/ethnicity included Asian or Pacific Islander (n = 12) and one write-in response of each of the following: Arab, Biracial, Caucasian, Irish, Jamaican, Jewish, Mixed, and Roma.

HIV Status/PrEP Use and HPV Vaccination Uptake

In multivariable analysis, participants who indicated that they were either living with HIV (8.7%) or had used PrEP (17.1%) were significantly more likely to have received at least one dose of the HPV vaccination compared to participants who were HIV-negative/unknown and never on PrEP (74.2%) (PR = 2.48, 95% CI = 1.52–4.07; PR = 1.70, 95% CI = 1.26–2.31, respectively).

HPV Vaccination Uptake by Other Factors

In multivariable analysis, men without insurance were less likely to have received at least one dose of the HPV vaccine compared to men with public insurance (PR = 0.60, 95% CI =0.37–0.97); no significant difference was observed comparing men with public versus private insurance. Compared to single men, men currently in a relationship were less likely to have received at least one dose of the HPV vaccine (PR = 0.76, 95% CI = 0.59–0.98). Finally, men recruited through men-for-men geosocial networking apps had significantly lower prevalence of receiving at least one dose of the HPV vaccine compared to participants recruited through social media (PR = 0.49, 95% CI = 0.33–0.75). There were no significant differences in HPV vaccine uptake observed by race/ethnicity, sexual orientation, or gender identity. Additionally, race and ethnicity was associated with HPV vaccination status in bivariate analysis but not significant in our fully-adjusted analysis. See Table 2 for full results.

Table 2.

Demographics and HIV- and pre-exposure prophylaxis (PrEP) use status and their association with human papillomavirus (HPV) vaccination among young sexual minority men recruited online (N = 287)

HPV Vaccination §
Categorical Variables n % χ2 statistic aPR 95% CI
Gender Identity 1.9
 Cisgender man 105 43.2 -- --
 Transgender man 24 54.5 1.26 0.89–1.77
Relationship Status 1.1
 Single 82 47.4 -- --
 In relationship 47 41.2 0.76* 0.59–0.98
Sexual Orientation 1.8
 Gay 79 45.1 -- --
 Bisexual 41 42.7 0.99 0.76–1.30
 Queer 7 63.6 1.14 0.72–1.79
 Another 2 40.0 0.74 0.24–2.31
Race/ethnicity 12.8**
 Black, non-Hispanic 38 35.5 0.87 0.61–1.25
 Latinx or Hispanic 27 45.0 0.86 0.62–1.19
 White, non-Hispanic 54 59.3 -- --
 Multiracial/another 10 34.5 0.64 0.39–1.06
Recruitment Source 18.6***
 Social media 103 53.9 -- --
 Men-for-men geosocial networking app 26 27.1 0.49** 0.33–0.75
Insurance Status 14.8**
 Currently insured through private insurance 85 55.2 -- --
 Currently insured through public insurance 31 35.6 0.73 0.52–1.00
 Currently uninsured 13 28.3 0.60* 0.37–0.97
HIV Status and PrEP Use 11.3**
 Living with HIV 13 52.0 2.48*** 1.52–4.07
 Prescribed PrEP/previously on PrEP (HIV-negative) 32 65.3 1.70** 1.26–2.31
 HIV-negative/unknown, never on PrEP 84 39.4 -- --
Continuous Variables M SD PR (95% CI) aPR 95% CI
Age (Range: 17–24) 20.6 2.6 1.00 (0.95–1.05) 0.99 0.94–1.05
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Note: Percentages may not add up to 100 due to rounding.

PR = prevalence ratio

aPR = adjusted prevalence ratio

§

One or more doses

*

p < 0.05,

**

p < 0.01,

***

p < 0.001

DISCUSSION

The purpose of this study was to examine uptake of the HPV vaccine by HIV and PrEP use status, insurance status, and other demographic characteristics among YSMM in the U.S. Our results show that participants currently or previously prescribed PrEP and those living with HIV were significantly more likely to have received at least one dose of the HPV vaccine than participants that were never on PrEP. A minority of individuals that could benefit from PrEP are currently taking it (AVAC, 2019; John, Rendina, et al., 2019; John, Robles, et al., 2019), and there are still many individuals who could benefit currently unvaccinated for HPV. Overall, HPV vaccination rates have been increasing. From 2013 to 2018 HPV, vaccination rates among men aged 18–26 increased from 7.7% to 27.0% (CDC, 2020b). As of 2017, 17.9% of SMM and 32.8% of YSMM received at least one dose of the HPV vaccine, and as of 2011 the proportion of YSMM reporting any HPV vaccination increased six-fold (McClung, Burnett, Wejnert, Markowitz, & Meites, 2020). This is in agreement with similar studies that found HPV vaccination uptake to be increasing over the last decade (Boersma & Black, 2020; Halkitis et al., 2019; Loretan, Chamberlain, Sanchez, Zlotorzynska, & Jones, 2019; Morgan et al., 2021; Reiter, McRee, Katz, & Paskett, 2015). Similarly, our newer study found an even higher uptake of vaccination with 45.0% of YSMM we surveyed indicating that they had received at least one dose of the HPV vaccine. However, this also demonstrates that more than half of participants were unvaccinated and indicates potential populations of YSMM who are being missed by vaccination campaigns. Efforts to continuously upscale HPV vaccinations among YSMM are extremely important, as simulation modeling by Goldstein and colleagues indicated anal HPV prevalence would decline by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80% and 100%, respectively (Goldstein et al., 2019). Prevention efforts and interventions are needed to extend access to both PrEP and HPV vaccination. Additionally, given that YSMM are disproportionately affected by HIV (CDC, 2021b), leveraging HIV prevention interventions including PrEP could be particularly impactful in expanding access to HPV vaccination since PrEP has been described as a gateway to primary care (Marcus et al., 2018).

Our analysis showed that participants who were uninsured were less likely to have received at least one dose of the HPV vaccine. Historically, studies have shown that SMM and other sexual minorities are less likely to have health insurance than straight individuals (Buchmueller & Carpenter, 2010; Ponce, Cochran, Pizer, & Mays, 2010), resulting in structural barriers to preventive care. SMM also face issues such as lack of employer-provided healthcare from partners due to nonrecognition of same-sex partnerships from state-level discriminatory policies (Ash & Lee Badgett, 2006). It is important to note that the changing socio-political environment is affecting SMM and access to health care. Researchers found increasing marriage equality from 2008–2017 led to a 0.61 percentage point increase in insurance among U.S. adults, likely due to the increasing recognition of same-sex marriages. Despite these advances, these researchers found that there was no measurable decline in uninsurance rates in the same time period (Downing & Cha, 2020). This indicates that there is still work to be done, and these issues further interact with other sociodemographic factors affecting healthcare access such as race/ethnicity and gender, leading to expansive barriers to health care access (Clift & Kirby, 2012).

Structural issues result in many access to care barriers among SMM. Lower income SMM have historically reported fewer healthcare visits compared to their higher income counterparts (McKirnan, Du Bois, Alvy, & Jones, 2013). Additionally, it is important to note that we did not assess racism, but racism is a known barrier to care engagement among Black YSMM (Eaton et al., 2015; Quinn et al., 2019). SMM have reported feeling discriminated against in health care settings (Calabrese et al., 2019), which has resulted in concealing their sexual identity. Identity concealment has implications for standard of care received, including being less likely to receive appropriate preventive health services recommended to them by providers (Petroll & Mosack, 2011). Race/ethnicity was not significant in our multivariable model despite large differences observed in bivariate analysis. Only 35.5% of Black YSMM received at least one dose of the HPV vaccine in our sample, which is lower than reported in the P18 longitudinal cohort in New York City with 42.9% of Black YSMM fully or partially vaccinated against HPV in 2015 (Halkitis et al., 2019) yet higher than the 17.0% of Black YSMM reported by the U.S. National HIV Behavioral Surveillance study in 2014 (Oliver, Hoots, Paz-Bailey, Markowitz, & Meites, 2017). Nationwide, our study in conjunction with National HIV Behavioral Surveillance study data indicate Black YSMM have lower rates of HPV vaccination compared to their white counterparts, indicating the need for further intervention. The use of online platforms—especially geosocial networking apps—is a promising avenue for targeted interventions to increase HPV vaccination among unvaccinated YSMM.

Participants recruited from men-for-men geosocial networking apps were less likely than participants recruited from social networking apps to have received at least one dose of the HPV vaccine, indicating a potential avenue for intervention. This finding is also concerning given that HPV is sexually transmitted and individuals on men-for-men geosocial networking apps are often—but not always—specifically seeking sexual partners. Targeted advertisements and notifications could be a promising avenue to support HPV vaccination, as well as PrEP uptake. SMM are receptive to health messaging and embedded interventions within apps they already use (Ventuneac, John, Whitfield, Mustanski, & Parsons, 2018), and the ability of geolocated positioning to direct users to local LGBTQ+ friendly providers would be particularly impactful given the aforementioned discriminatory barriers to primary care for YSMM. These location-based interventions have already been developed for HIV prevention (e.g., the PrEP Locator) (Siegler, Wirtz, Weber, & Sullivan, 2017) and could be further leveraged to promote HPV vaccination and PrEP uptake in tandem.

Online vaccine messaging must be done with careful precision. It is important to recognize that social media has also caused a significant increase in distrust toward vaccines and health care in general (Ache & Wallace, 2008; Davies, Chapman, & Leask, 2002; Evrony & Caplan, 2017; Keelan, Pavri, Balakrishnan, & Wilson, 2010; Tafuri et al., 2014). Therefore it is important now more than ever before to ensure information disseminated through social media is factual and raises trust among users. In 2015, researchers found 80% of respondents used public search engines to find information on child health, and only 50% stated that they crosschecked information found online with physicians (Pehora et al., 2015). Morever, YSMM report using the internet to educate themselves regarding topics of sexual health (Grov, Breslow, Newcomb, Rosenberger, & Bauermeister, 2014; Mustanski, Lyons, & Garcia, 2011). Therefore ensuring information is easily accessible and factual, as well as disseminated via social media, and particularly via men-for-men social networking apps, could be a way to increase HPV vaccine uptake.

We found that participants currently in a relationship were less likely to have received at least one dose of the HPV vaccine. This could indicate participants in relationships perceived less of a need to be vaccinated and trusted their partner to be HPV free or believe that they are not likely to contract HPV. However, studies have shown that HPV infection rates are extremely high among SMM (Morgan et al., 2021) and vaccination is most effective before exposure to high-risk HPV serotypes (CDC, 2021a; Machalek et al., 2012). Therefore, vaccinating individuals in relationships is still important to prevent future infections, contrary to many HIV prevention interventions which consider mutually-monogamous relationships to be a method of prevention alone (CDC, 2017). As such, YSMM in relationships could require nuanced dyadic interventions to support HPV vaccination.

Limitations

There were several limitations pertinent to our study. First, we only recruited participants using social media and geosocial networking apps, potentially limiting generalizability, although most YSMM use social media and networking apps, and prior studies have found that SMM that do not engage in social media are generally older, but are not significantly different in terms of gender, race, sexual orientation, residency, income, or education (CDC, 2013; Horvath et al., 2012). Second, it is possible our results were affected by misclassification bias since the measures were self-reported. Lastly, the cross-sectional nature of our study means we are unable to determine temporality between PrEP and HPV vaccination; causal claims must be tempered.

CONCLUSIONS

Both PrEP and the HPV vaccine are highly effective at preventing HIV and HPV infection, respectively, among YSMM. Our research illuminated how these two interventions intersect and show YSMM who have been prescribed PrEP and those who are living with HIV to be significantly more likely to have received the HPV vaccine compared to those never on PrEP. We also examined how other sociodemographic factors relate to HPV vaccination and found that lack of insurance, having a current partner, and recruitment through men-for-men geosocial networking apps were associated with a lower likelihood of being HPV vaccinated. Interventions should target subgroups of YSMM with low vaccination rates to improve health outcomes.

ACKNOWLEDGEMENTS

Funding support was provided by the National Institute of Mental Health (K01-MH118939, PI: John; K01-MH112412, PI: Quinn). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We wish to thank our staff at the Center for AIDS Intervention Research at Medical College of Wisconsin, especially Karen Opgenorth, Kevin Brown, Tom Lytle, Thom Ertl, Erika Christenson, and Olivia Algiers. We also wish to thank our participants who volunteered their time.

Conflicts of Interest:

AEP receives research funding from Gilead Sciences, Inc. All other authors declare that they have no conflict of interest.

Footnotes

Ethics Approval: All study procedures were approved by the Institutional Review Board of the Medical College of Wisconsin.

Informed Consent: This study met the Medical College of Wisconsin Institutional Review Board’s definition of “minimal risk” and a waiver of informed consent was granted. All participants agreed to participate after reviewing the study’s informational letter. A waiver of guardian permission was obtained for those considered minors.

Availability of Data and Material (Data Transparency):

Data is available upon request to the Administrative Core of the Center for AIDS Intervention Research. Individuals who meet criteria for access to de-identified data should contact the Principal Investigator (sjohn@mcw.edu) or Karen Opgenorth (kopgnort@mcw.edu) to facilitate data transfer.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data is available upon request to the Administrative Core of the Center for AIDS Intervention Research. Individuals who meet criteria for access to de-identified data should contact the Principal Investigator (sjohn@mcw.edu) or Karen Opgenorth (kopgnort@mcw.edu) to facilitate data transfer.

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