The HPV Vaccine for Young MSM

Gay couple sleeping
Gay couple sleeping. Image Source/Getty Images

Human papillomavirus can infect anyone, and it does. The vast majority of sexually active individuals will become infected with HPV at some point during their lives. However, there are certain groups that are more at risk of serious, adverse outcomes of HPV infection. Women, for example, have a significant risk of cervical cancer if persistent HPV infections remain undetected for long periods of time.

Men who have sex with men (MSM), particularly those who are HIV positive, are at elevated risk of anal cancer, for which testing is not always available.

Several HPV vaccines have become available in recent years. Although initially targeted at young women, vaccination recommendations have also been expanded to include young men. While ideally all eligible young men would be vaccinated, regardless of their sexual orientation, as the principles of herd immunity show that reducing HPV in young heterosexual men also will reduce it in young women (and across the board), young men who have sex with men are a particularly important population for vaccination.

Unfortunately, research suggests that not nearly enough young MSM are being vaccinated for HPV - at least not in a timely manner. Even when they're interested in being vaccinated, the vaccine may not be offered by their doctors. To be fair, this isn't a problem restricted to young MSM.

The rate of HPV vaccination in the U.S. is far lower than ideal, in part because of moral debates about vaccination and false information about safety risks.

It's also important to note that one of the difficulties associated with targeting young people for vaccination based on sexual risk is that it assumes doctors have an accurate ability to assess young people's sexual risk.

That is not a valid assumption. Doctors often do a terrible job of talking to their patients about sex, and many sexual and gender minority youth correctly fear that disclosing those factors of their identity to their doctor could result in stigma or discrimination. They may also have concerns about cost and related issues, even if stigma is not a concern.

In an ideal world everyone would be offered HPV vaccination... and STD screening... and HIV testing, regardless of questionable and uninformed perceptions of risk. Unfortunately that often doesn't happen, even when universal testing is the recommendation, such as it is for HIV.


Berenson AB. An update on barriers to adolescent human papillomavirus vaccination in the USA. Expert Rev Vaccines. 2015 Oct;14(10):1377-84. doi: 10.1586/14760584.2015.1078240.

Cummings T, Kasting ML, Rosenberger JG, Rosenthal SL, Zimet GD, Stupiansky NW. Catching Up or Missing Out? Human Papillomavirus Vaccine Acceptability Among 18- to 26-Year-old Men Who Have Sex With Men in a US National Sample. Sex Transm Dis. 2015 Nov;42(11):601-6. doi: 10.1097/OLQ.0000000000000358.

Meites E, Markowitz LE, Paz-Bailey G, Oster AM; NHBS Study Group. HPV vaccine coverage among men who have sex with men - National HIV Behavioral Surveillance System, United States, 2011. Vaccine. 2014 Nov 12;32(48):6356-9. doi: 10.1016/j.vaccine.2014.09.033.

Zou H, Grulich AE, Cornall AM, Tabrizi SN, Garland SM, Prestage G, Bradshaw CS, Hocking JS, Morrow A, Fairley CK, Chen MY. How very young men who have sex with men view vaccination against human papillomavirus. Vaccine. 2014 Jun 30;32(31):3936-41. doi: 10.1016/j.vaccine.2014.05.043.

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