Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study


Human papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.

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  1. 1.

    Satterwhite, C. L., Torrone, E., Meites, E., Dunne, E. F., Mahajan, R., Ocfemia, M. C. B., et al. (2013). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sexually Transmitted Diseases,40(3), 187–193.

    PubMed  Google Scholar 

  2. 2.

    McQuillan, G. M., Kruszon-Moran, D., Markowitz, L. E., Unger, E. R., & Paulose-Ram, R. (2017). Prevalence of HPV in adults aged 18–69: United States, 2011–2014 [NCHS data brief, no. 280]. Hyattsville: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

    Google Scholar 

  3. 3.

    Dunne, E. F., Unger, E. R., Sternberg, M., McQuillan, G., Swan, D. C., Patel, S. S., et al. (2007). Prevalence of HPV infection among females in the United States. JAMA,297(8), 813–819.

    CAS  PubMed  Google Scholar 

  4. 4.

    Dunne, E. F., Nielson, C. M., Stone, K. M., Markowitz, L. E., & Giuliano, A. R. (2006). Prevalence of HPV infection among men: A systematic review of the literature. Journal of Infectious Diseases, 194(8), 1044–1057.

    PubMed  Google Scholar 

  5. 5.

    Cates, W. (1999). Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sexually Transmitted Diseases, 26(4S), S2–S7.

    PubMed  Google Scholar 

  6. 6.

    Hoots, B. E., Palefsky, J. M., Pimenta, J. M., & Smith, J. S. (2009). Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions. International Journal of Cancer, 124(10), 2375–2383.

    CAS  PubMed  Google Scholar 

  7. 7.

    Smith, J. S., Backes, D. M., Hoots, B. E., Kurman, R. J., & Pimenta, J. M. (2009). Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstetrics & Gynecology, 113(4), 917–924.

    Google Scholar 

  8. 8.

    Muñoz, N., Bosch, F. X., de Sanjose, S., Herrero, R., Castellsagué, X., Shah, K. V., et al. (2003). Epidemiologic classification of human papillomavirus types associated with cervical cancer. New England Journal of Medicine,348(6), 518–527.

    PubMed  Google Scholar 

  9. 9.

    Muñoz, N., Castellsagué, X., de González, A. B., & Gissmann, L. (2006). HPV in the etiology of human cancer. Vaccine, 24(S3), S1–S10.

    Google Scholar 

  10. 10.

    Gross, G., & Pfister, H. (2004). Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Medical Microbiology and Immunology, 193(1), 35–44.

    CAS  PubMed  Google Scholar 

  11. 11.

    McNamara, M., Batur, P., Walsh, J. M. E., & Johnson, K. M. (2016). HPV update: Vaccination, screening, and associated disease. Journal of General Internal Medicine, 31(11), 1360–1366.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Food and Drug Administration, United States. (2018). FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [press release]. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old.

  13. 13.

    Reiter, P. L., Gilkey, M. B., & Brewer, N. T. (2013). HPV vaccination among adolescent males: Results from the National Immunization Survey-Teen. Vaccine,31(26), 2816–2821.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Gilkey, M. B., Moss, J. L., McRee, A. L., & Brewer, N. T. (2012). Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine, 30(41), 5928–5934.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Holman, D. M., Benard, V., Roland, K. B., Watson, M., Liddon, N., & Stokley, S. (2014). Barriers to human papillomavirus vaccination among US adolescents: A systematic review of the literature. JAMA Pediatrics, 168(1), 76–82.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Reiter, P. L., McRee, A. L., Katz, M. L., & Paskett, E. D. (2015). Human papillomavirus vaccination among young adult gay and bisexual men in the United States. American Journal of Public Health, 105(1), 96–102.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Reiter, P. L., Brewer, N. T., McRee, A. L., Gilbert, P., & Smith, J. S. (2010). Acceptability of HPV vaccine among a national sample of gay and bisexual men. Sexually Transmitted Diseases, 37(3), 197–203.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Gerend, M. A., Madkins, K., Phillips, G., & Mustanski, B. (2016). Predictors of human papillomavirus vaccination among young men who have sex with men. Sexually Transmitted Diseases, 43(3), 185–191.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Nyitray, A. G., Carvalho da Silva, R. J., Baggio, M. L., Lu, B., Smith, D., Abrahamsen, M., et al. (2011). Age-specific prevalence of and risk factors for anal human papillomavirus (HPV) among men who have sex with women and men who have sex with men: The HPV in Men (HIM) study. Journal of Infectious Diseases,203(1), 49–57.

    PubMed  Google Scholar 

  20. 20.

    Oliver, S. E., Hoots, B. E., Paz-Bailey, G., Markowitz, L. E., Meites, E., & NS Group. (2017). Increasing human papillomavirus vaccine coverage among men who have sex with men—National HIV Behavioral Surveillance, United States, 2014. JAIDS,75(S3), S370–S374.

    PubMed  Google Scholar 

  21. 21.

    Meites, E., Gorbach, P. M., Gratzer, B., Panicker, G., Steinau, M., Collins, T., et al. (2016). Monitoring for human papillomavirus vaccine impact among gay, bisexual, and other men who have sex with men—United States, 2012–2014. Journal of Infectious Diseases,214(5), 689–696.

    CAS  PubMed  Google Scholar 

  22. 22.

    Charlton, B. M., Reisner, S. L., Agenor, M., Gordon, A. R., Sarda, V., & Austin, S. B. (2017). Sexual orientation disparities in human papillomavirus vaccination in a longitudinal cohort of U.S. males and females. LGBT Health, 4(3), 202–209.

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Bednarczyk, R. A., Whitehead, J. L., & Stephenson, R. (2017). Moving beyond sex: Assessing the impact of gender identity on human papillomavirus vaccine recommendations and uptake among a national sample of rural-residing LGBT young adults. Papillomavirus Research, 3, 121–125.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Apaydin, K. Z., Fontenot, H. B., Shtasel, D., Dale, S. K., Borba, C. P., Lathan, C. S., et al. (2018). Facilitators of and barriers to HPV vaccination among sexual and gender minority patients at a Boston community health center. Vaccine,36(26), 3868–3875.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Halkitis, P. N., Valera, P., LoSchiavo, C. E., Goldstone, S. E., Kanztanou, M., Maiolatesi, A. J., et al. (2019). Human papillomavirus vaccination and infection in young sexual minority men: The P18 Cohort Study. AIDS Patient Care and STDs,33(4), 149–156.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Meites, E., Markowitz, L. E., Paz-Bailey, G., & Oster, A. M. (2014). HPV vaccine coverage among men who have sex with men—National HIV Behavioral Surveillance System, United States, 2011. Vaccine, 32(48), 6356–6359.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Chin-Hong, P. V., Husnik, M., Cranston, R. D., Colfax, G., Buchbinder, S., Da Costa, M., et al. (2009). Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS,23(9), 1135.

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    Rositch, A. F., Gravitt, P. E., & Smith, J. S. (2013). Growing evidence that HPV infection is associated with an increase in HIV acquisition: Exploring the issue of HPV vaccination. BMJ Sexually Transmitted Infections, 89(5), 357.

    Google Scholar 

  29. 29.

    Houlihan, C. F., Larke, N. L., Watson-Jones, D., Smith-McCune, K. K., Shiboski, S., Gravitt, P. E., et al. (2012). Human papillomavirus infection and increased risk of HIV acquisition: A systematic review and meta-analysis. AIDS,26(17), 2211–2222.

    PubMed  Google Scholar 

  30. 30.

    Bennetts, L. E., Wagner, M., Giuliano, A. R., Palefsky, J. M., Steben, M., & Weiss, T. W. (2015). Associations of anogenital low-risk human papillomavirus infection with cancer and acquisition of HIV. Sexually Transmitted Diseases, 42(10), 541–544.

    CAS  PubMed  Google Scholar 

  31. 31.

    Lissouba, P., Van de Perre, P., & Auvert, B. (2013). Association of genital human papillomavirus infection with HIV acquisition: A systematic review and meta-analysis. Sexually Transmitted Infections, 89(5), 350–356.

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Chin-Hong, P. V., & Palefsky, J. M. (2005). Human papillomavirus anogenital disease in HIV-infected individuals. Dermatological Therapy, 18(1), 67–76.

    Google Scholar 

  33. 33.

    Palefsky, J. M. (2006). Biology of HPV in HIV infection. Advances in Dental Research, 19(1), 99–105.

    CAS  PubMed  Google Scholar 

  34. 34.

    Gormley, R. H., & Kovarik, C. L. (2009). Dermatologic manifestations of HPV in HIV-infected individuals. Current HIV/AIDS Reports, 6(3), 130–138.

    PubMed  Google Scholar 

  35. 35.

    Cummings, T., Kasting, M. L., Rosenberger, J. G., Rosenthal, S. L., Zimet, G. D., & Stupiansky, N. W. (2015). 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. Sexually Transmitted Diseases, 42(11), 601–606.

    CAS  PubMed  Google Scholar 

  36. 36.

    Newman, P. A., Logie, C. H., Doukas, N., & Asakura, K. (2013). HPV vaccine acceptability among men: A systematic review and meta-analysis. Sexually Transmitted Infections, 89(7), 568.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Brewer, N. T., Ng, T. W., McRee, A. L., & Reiter, P. L. (2010). Men’s beliefs about HPV-related disease. Journal of Behavioral Medicine, 33(4), 274–281.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Stupiansky, N. W., Alexander, A. B., & Zimet, G. D. (2012). Human papillomavirus vaccine and men: What are the obstacles and challenges? Current Opinion in Infectious Diseases, 25(1), 86–91.

    PubMed  Google Scholar 

  39. 39.

    Luk, J. W., Gilman, S. E., Haynie, D. L., & Simons-Morton, B. G. (2017). Sexual orientation differences in adolescent health care access and health-promoting physician advice. Journal of Adolescent Health, 61(5), 555–561.

    PubMed  Google Scholar 

  40. 40.

    Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among U.S. adults: National Health Interview Survey. 2013. National Health Statistics Report, 77, 1–10.

    Google Scholar 

  41. 41.

    LaVeist, T. A., Nickerson, K. J., & Bowie, J. V. (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Medical Care Research and Review, 57(S1), 146–161.

    PubMed  Google Scholar 

  42. 42.

    LaVeist, T. A. (2005). Disentangling race and socioeconomic status: A key to understanding health inequalities. Journal of Urban Health,82(2 Supp 3), iii26–iii34.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    LaVeist, T. A., Isaac, L. A., & Williams, K. P. (2009). Mistrust of health care organizations is associated with underutilization of health services. Health Services Research, 44(6), 2093–2105.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Khalili, J., Leung, L. B., & Diamant, A. L. (2015). Finding the perfect doctor: Identifying lesbian, gay, bisexual, and transgender-competent physicians. American Journal of Public Health, 105(6), 1114–1119.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Moll, J., Krieger, P., Moreno-Walton, L., Lee, B., Slaven, E., James, T., et al. (2014). The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: What do we know? Academic Emergency Medicine,21(5), 608–611.

    PubMed  Google Scholar 

  46. 46.

    Nowaskie, D. Z., & Sowinski, J. S. (2018). Primary care providers’ attitudes, practices, and knowledge in treating LGBTQ communities. Journal of Homosexuality, 66(13), 1927–1947.

    PubMed  Google Scholar 

  47. 47.

    Halkitis, P. N., Kapadia, F., Bub, K. L., Barton, S., Moreira, A. D., & Stults, C. B. (2015). A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 cohort study. AIDS and Behavior, 19(6), 970–980.

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Storholm, E. D., Solomon, T. M., & Bub, K. L. (2013). Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS and Behavior, 17(2), 662–673.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Paul, G., Noel, T. B., Paul, L. R., Terence, W. N., & Jennifer, S. S. (2010). HPV vaccine acceptability in heterosexual, gay, and bisexual men. American Journal of Men's Health, 5(4), 297–305.

    Google Scholar 

  50. 50.

    Wheldon, C. W., Daley, E. M., Buhi, E. R., Nyitray, A. G., & Giuliano, A. R. (2011). Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States. Vaccine, 29(45), 8060–8065.

    PubMed  Google Scholar 

  51. 51.

    Halkitis, P. N., Kapadia, F., Ompad, D. C., & Perez-Figueroa, R. (2015). Moving toward a holistic conceptual framework for understanding healthy aging among gay men. Journal of Homosexuality, 62(5), 571–587.

    PubMed  Google Scholar 

  52. 52.

    Halkitis, P. N. (2010). Reframing HIV prevention for gay men in the United States. American Psychologist, 65(8), 752–763.

    PubMed  Google Scholar 

  53. 53.

    Halkitis, P. N., Cook, S. H., Ristuccia, A., Despotoulis, J., Levy, M. D., Bates, F. C., et al. (2018). Psychometric analysis of the life worries scale for a new generation of sexual minority men: The P18 Cohort Study. Health Psychology,37(1), 89–101.

    PubMed  Google Scholar 

  54. 54.

    Halkitis, P. N. (2013). The AIDS generation: Stories of survival and resilience. New York: Oxford University Press.

    Google Scholar 

  55. 55.

    Halkitis, P. N. (2019). Out in time: From Stonewall to queer, how gay men came of age across the generations. New York: Oxford University Press.

    Google Scholar 

  56. 56.

    Goedel, W. C., King, M. R. F., Lurie, M. N., Nunn, A. S., Chan, P. A., & Marshall, B. D. L. (2019). Effect of racial inequities in pre-exposure prophylaxis use on racial disparities in HIV incidence among men who have sex with men: A modeling study. JAIDS,79(3), 323–329.

    Google Scholar 

  57. 57.

    Misra, K., Huang, J. S., & Udeagu, C. (2019). Ongoing disparities in prediagnosis preexposure prophylaxis use among persons recently diagnosed with HIV in New York City, 2015–2017. American Journal of Public Health, 109(9), 1212–1215.

    PubMed  Google Scholar 

  58. 58.

    Crepaz, N., Dong, X., Wang, X., Hernandez, A. L., & Hall, H. I. (2018). Racial and ethnic disparities in sustained viral suppression and transmission risk potential among persons receiving HIV care—United States, 2014. Morbidity and Mortality Weekly Report, 67(4), 113–118.

    PubMed  PubMed Central  Google Scholar 

  59. 59.

    Giuliano, A. R., Joura, E. A., Garland, S. M., Huh, W. K., Iversen, O. E., Kjaer, S. K., et al. (2019). Nine-valent HPV vaccine efficacy against related diseases and definitive therapy: Comparison with historic placebo population. Gynecologic Oncology,154(1), 110–117.

    CAS  PubMed  Google Scholar 

  60. 60.

    Giacomet, V., Penagini, F., Trabattoni, D., Viganò, A., Rainone, V., Bernazzani, G., et al. (2014). Safety and immunogenicity of a quadrivalent human papillomavirus vaccine in HIV-infected and HIV-negative adolescents and young adults. Vaccine,32(43), 5657–5661.

    CAS  PubMed  Google Scholar 

  61. 61.

    Giuliano, A. R., Palefsky, J. M., Goldstone, S., Moreira, E. D., Penny, M. E., Aranda, C., et al. (2011). Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. New England Journal of Medicine,364(5), 401–411.

    CAS  PubMed  Google Scholar 

  62. 62.

    Daley, E. M., Vamos, C. A., Thompson, E. L., Zimet, G. D., Rosberger, Z., Merrell, L., et al. (2017). The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. Papillomavirus Research,3, 142–148.

    PubMed  PubMed Central  Google Scholar 

  63. 63.

    Chido-Amajuoyi, O. G., Domgue, J. F., Obi-Jeff, C., Schmeler, K., & Shete, S. (2019). A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa. The Lancet Global Health, 7(1), e20–e21.

    PubMed  Google Scholar 

  64. 64.

    Katz, M. L., Krieger, J. L., & Roberto, A. J. (2011). Human papillomavirus (HPV): College male's knowledge, perceived risk, sources of information, vaccine barriers and communication. Journal of Men's Health, 8(3), 175–184.

    PubMed  PubMed Central  Google Scholar 

  65. 65.

    Halkitis, P. N., Maiolatesi, A. J., & Krause, K. D. (In Press). The health challenges of emerging adult gay men: Effecting a change in healthcare. Clinical Review Articles.

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This work was supported by the National Institute on Drug Abuse [1R01DA0225537, 2R01DA025537] and the National Institute of Allergy and Infectious Diseases [R01AI132020, R56AI122000].

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Jaiswal, J., LoSchiavo, C., Maiolatesi, A. et al. Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study. J Community Health 45, 702–711 (2020). https://doi.org/10.1007/s10900-019-00784-w

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  • Human papillomavirus
  • HPV
  • Health communication
  • Sexual minority men