Tom Nadarzynski

Human papillomavirus and vaccine-related perceptions among men who have sex with men: a systematic review

Background Targeted human papillomavirus (HPV) vaccine could prevent HPV-related cancers and genital warts among men who have sex with men (MSM). In order to develop effective vaccination programmes for MSM, it is crucial to understand their knowledge, beliefs about HPV and attitudes towards HPV vaccine. Methods A systematic search of 10 databases examined articles investigating HPV knowledge and HPV-related perceptions among MSM. Each paper was assessed to identify potential research directions in the context of targeted HPV vaccination for MSM. Results We identified 16 studies that included 5185 MSM and conducted mainly in North America. Generally, participants were over 26 years old, had poor-to-moderate knowledge about HPV and were not concerned about HPV-related diseases. Over a half of MSM were willing to accept HPV vaccine, if offered. However, there was large variability in HPV vaccine acceptability, partially due to inconsistencies in methods of ascertainment but also different levels of HPV vaccine awareness. Conclusions Despite several misconceptions and poor knowledge of HPV infection, MSM might be receptive to HPV vaccination. However, further research is needed to identify which factors contribute to potential vaccine uptake in hypothetical MSM-targeted HPV vaccination. Future studies need to target those MSM with little sexual experience, who would benefit most from HPV vaccination.

Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex

Abstract There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the ‘gay scene’ on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic ‘risk-environments’ and ‘littoral spaces’ in which chemsex and risk behaviours are played out.

Sexual healthcare professionals’ views on HPV vaccination for men in the UK

Background:Human Papillomavirus (HPV) vaccination for men could prevent anal cancers amongst men who have sex with men (MSM).Methods:An e-survey of attitudes towards vaccination for men in the UK was conducted in July–August 2014.Results:Among 325 sexual health professionals, 14% were already vaccinating men against HPV, 83% recommended gender-neutral HPV vaccination and 65% recommended targeting MSM. Over 50% reported having poor knowledge about the use of HPV vaccine for MSM and the skills to identify MSM likely to benefit from HPV vaccination.Conclusions:Clear advice and guidelines on HPV vaccine use for men at sexual health clinics are required to ensure equitable opportunities for vaccination.

Men who have sex with men who do not access sexual health clinics nor disclose sexual orientation are unlikely to receive the HPV vaccine in the UK

BACKGROUND Men who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer. PURPOSE To examine HPV vaccine acceptability amongst MSM in the UK. METHODS Using advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability. RESULTS Out of 1508 MSM (median age = 22, range: 14-63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29-2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39-3.14] and HIV-positive status [OR = 1.96, CI 1.09-3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05-1.63], HPV infection severity [OR = 1.89, CI 1.16-3.01), HPV vaccination benefits [OR = 1.61, CI 1.14-3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14-2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95-6.73] were also associated with acceptability. CONCLUSIONS Although nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation.

Preferences for the format of text messages containing results of online screening for sexually transmitted infections: a service evaluation

We conducted an online survey to examine the preferences for receiving a text message with results of a test for sexually transmitted infections (STIs) as part of online self-sampling service at Solent NHS Trust. Findings showed that if all tests were negative, participants would prefer to receive one text message. However, in the event of a positive result, a large majority (86%) would prefer to receive a separate text with the name of the STI for which the test was positive. Similarly, three-quarters (74%) of participants would prefer to receive multiple texts indicating which test was inconclusive and required an additional sample. The results of this survey support a change of practice to sending multiple text messages with the results of online self-sampling that include the names of STIs.

‘Jabs for the boys’: time to deliver on HPV vaccination recommendations

Human papillomavirus (HPV) vaccination programmes in the UK were established in 2008, and targeted females aged 12–13 years. This decision was based on recommendations from the Joint Committee for Vaccination and Immunisation (JCVI), after assessing the available evidence for the impact and cost effectiveness of HPV vaccination programmes. The theory was that reducing HPV rates in females would result in lower infection rates in males of a similar age. This herd immunity did not extend to men-who-have-sex-with-men (MSM) or heterosexual men having sex abroad. Public Health England (PHE) undertook a trial of a targeted HPV vaccination programme for MSM in 2016–2017. The 12-month pilot involved MSM up to 45 years of age being offered Gardasil® 4, a quadrivalent HPV vaccine, through genitourinary medicine (GUM) and HIV clinics across England. GPs were not included in the pilot as there was insufficient evidence of acceptability and effective delivery. The pilot was reported as a success, and PHE has recommended rolling out this programme across England.1 The JCVI issued an interim statement regarding extending HPV immunisation to adolescent males in July 2017, again concluding that there was insufficient evidence for benefit in males.2 However, after strong responses through stakeholder consultations, continued pressure from lobby groups such as HPV Action (www.hpvaction.org), and further analysis of the latest research, the JCVI recently (18 July 2018) recommended extending the HPV vaccination programme to adolescent males.3 HPV is a major cause of infection-related cancers. It is associated with cervical, anal, oropharyngeal, penile, vulval and vaginal …

O13 ‘I was struggling to feel intimate, the drugs just helped’. chemsex and HIV-risk among men who have sex with men (MSM) in the uk: syndemics of stigma, minority-stress, maladaptive coping and risk environments

Introduction There has been a steep rise in the use of drugs during sex by some men who have sex with men (MSM), with associated increases in sexual risk for HIV and other STIs. This ‘Chemsex’ has been described, but there is a lack of theoretical perspectives applied to this particular phenomenon. We aimed to assess participants’ reasoning and conceptualisation of Chemsex and situate this within theoretical frameworks. Methods This study presents data from telephone interviews with 15 MSM attending sexual health clinics following a risk of HIV and accessing post-exposure prophylaxis (PEP). Interviews were conducted as part of a larger interventional study, which used an adapted version of Motivational Interviewing to explore risk behaviour and support change. We used Framework analysis on interview transcripts in order to understand participants’ perspectives on the use of chemsex. Results Participants conceptualised their chemsex and HIV risks in their psycho-social context, highlighting the influence of the psycho-socio-cultural challenges of homophobic marginalisation and the ‘gay scene’ on their behaviour. Narratives of loneliness and difficulties in forming satisfying social and sexual relationships were repeatedly identified. Discussion Multiple influences of stigma, minority stress and maladaptive coping (including drug-use) are seen to contribute to syndemic ‘risk-environments’ in which chemsex and risk behaviours are played out. Interventions to address the harms of chemsex must recognise the complex psychosocial context of risk, and shift the responsibility for change from vulnerable individuals to a shared responsibility distributed across social, political and institutional contexts.

Perceptions of HPV and attitudes towards HPV vaccination among men who have sex with men: a qualitative analysis

Abstract Background Men who have sex with men (MSM) are at risk of genital warts and anal cancer due to human papillomavirus (HPV) infection. From 2016, MSM are being targeted for HPV vaccination in the UK through sexual health settings. This study explored perceptions of HPV and HPV vaccination among MSM. Methods Focus groups and one-to-one interviews with self-identified MSM from Brighton, UK, were conducted between Nov 20, 2014, and March 15, 2015. Participants were recruited from community-based lesbian–gay–bisexual–transgender venues and organisations. Discussions were recorded, transcribed verbatim, and analysed with framework analysis. Ethics approval was granted from Brighton and Sussex Medical School. Findings 33 men took part (median age 25 years, IQR 21–27), most of whom did not know about HPV (n=25), anal cancer (31), or HPV vaccination (26). Whereas genital warts and anal cancer were perceived as severe, men did not perceive themselves at risk for HPV. All MSM would accept the HPV vaccine if offered by a health-care professional. The inability to self-identify as gay or bisexual, access to sexual health services, and discussing sexuality with health-care professionals were barriers to HPV vaccination. Two MSM were concerned that selective HPV vaccination would increase stigma and prejudice comparable to the AIDS epidemic. Ten MSM were unsure about the effectiveness of HPV vaccination for sexually active men and were in favour of vaccinating all adolescent boys at school. Interpretation Most MSM have poor knowledge about HPV and associated anal cancer. Despite the lack of concern about HPV-related diseases, MSM would be willing to receive the HPV vaccine. There is a need for health education about the risk of HPV and HPV-related diseases so that MSM can appraise the benefits of the HPV vaccine for their health. Concerns about HPV vaccine effectiveness in sexually active men and possible stigmatisation need to be addressed to increase HPV vaccine acceptability. Funding This work was funded through a competitive PhD scholarship from the University of Brighton.

Delay in disclosure about sexual orientation to health-care professionals among men who have sex with men in Brighton, UK: a qualitative analysis

Abstract Background Men who have sex with men (MSM) are at risk of poor sexual health and can benefit from preventive health interventions, such as vaccination and screening. For these interventions to be most effective, it is crucial that men can openly discuss same-sex sexual behaviours with health-care professionals at the beginning of their sexual activity. This study aimed to explore the barriers and facilitators to disclosure of sexual orientation among MSM. Methods The study involved four focus groups (five participants each) and 13 one-to-one interviews with self-identified MSM from Brighton, UK, between Nov 20, 2014, and March 15, 2015. Participants were recruited from community-based lesbian–gay–bisexual–transgender venues and organisations. Discussions were recorded, transcribed verbatim, and analysed with framework analysis. Ethics approval was granted from Brighton and Sussex Medical School. Findings 33 men (mean age 25 years, SD 5, range 18–40) took part. Eight themes were identified. MSM reported that the attributes of a doctor and the characteristics of a clinic or surgery were important when judging the relevance of sexual orientation in their health care. Men who had negative experiences talking about their sexuality or did not associate themselves with the gay culture were less likely to reveal same-sex practices. Some men acknowledged that having a support network and feeling confident as a gay man enabled them to be open about sexual orientation. Questionnaires and direct face-to-face questions were perceived as acceptable ways to reveal sexual orientation. Almost all men admitted that they had waited until they felt it was important, safe, or worthwhile to discuss sexual orientation. Interpretation Most participants had delayed disclosure of sexual orientation until they perceived it to be relevant to health care and felt certain about confidentiality. To encourage MSM to discuss their health and wellbeing with health-care professionals, services need to inform MSM about the benefits and acceptance of disclosing sexual behaviours. Future studies should explore strategies to remove barriers and to communicate a welcoming approach to stigmatised sexual minorities. Funding This work was funded through a competitive PhD scholarship from the University of Brighton.