Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men

This study aimed to explore and compare the knowledge and attitudes of United Kingdom (UK) general practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding human papillomavirus (HPV) vaccination for young men who have sex with men (YMSM) aged 16-24. It was carried out based on the belief that is crucial to engage widely with HCPs expected to vaccinate YMSM against HPV. The researchers contend that it is also important to identify appropriate strategies to support any new HPV vaccination programmes in the future and highlight any barriers and facilitators to the programmes' effective implementation.

As explained here, over 70% of MSM are carriers of HPV, which is associated with anogenital and oropharyngeal cancers. The UK's current strategy is to offer publicly funded vaccination only to girls aged 12-14, which is intended to protect males through herd immunity. In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the HPV vaccination programme be extended to MSM aged up to 45 years via genitourinary medicine (GUM) clinics (where SHCPs practice), HIV clinics, or opportunistically through general practice clinics (where GPs practice). GPs will arguably have more opportunity to vaccinate men before sexual debut compared to GUM clinics, given that men are more likely to attend a GUM clinic after the first sexual encounter.

Another complicating factor is that the majority of men do not identify as gay or bisexual before they engage in sexual contact with other men, and many men do not disclose their sexual identity and/or behaviour to their physician. In attempts to address this issue, UK HCPs have recently been issued guidance from National Health Service (NHS) England recommending that they enquire about a patient's sexual orientation at "every face to face contact with the patient". According to the researchers, such policies have the potential to exacerbate stigmatisation of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. Thus, best practice guidance for discussing sexual behaviour has been produced by UK charities.

This cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs' lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were: less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (odds ratio (OR) = 0.02, 95% confidence interval (CI) = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). In short, GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs.

"Disparities in knowledge and attitudes towards HPV vaccination for YMSM between SHCPs and GPs, as suggested in this study's findings, may lead to differences in treatment and HPV prevention depending on where YMSM seek sexual health advice." The findings indicate that "GPs may have a low level of knowledge regarding HPV vaccination among young MSM, and implementing a targeted HPV vaccination programme for YMSM prior to exposure to HPV to maximise the cancer prevention potential that involved GPs would need investment in clinician education, training, and support."

In conclusion: "In order to implement the JCVI recommendation regarding HPV vaccination for MSM most effectively, YMSM should be identified early and offered the HPV vaccine with clear information. However, barriers to such implementation in primary care appear to still remain. If the findings of this exploratory work were confirmed in future research, interventions could be developed to raise awareness and educate GPs about the benefits of HPV vaccination for MSM, and to improve the skills of GPs in sensitively eliciting a patient's sexual orientation to benefit the consultation and the patient-doctor relationship."