Spanish-speaking men in sexual minority groups may lack knowledge about cancers linked to HPV

A study found multiple gaps in awareness and knowledge about the connection between the human papillomavirus (HPV) and several types of cancer among Hispanic and Latino men who identified as sexual minorities, according to results presented at the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 29–October 2, 2023.

"Sexual minority men are a population group at higher risk for HPV infections and subsequent HPV-related health concerns, including anal cancer," said Shannon M. Christy, Ph.D., assistant member in the Division of Population Science at Moffitt Cancer Center in Tampa, Florida. "Prior research has demonstrated suboptimal HPV vaccine uptake among young adults, including sexual minority men. Additional efforts are needed to ensure that all age-eligible community members can benefit from this effective cancer prevention method."

Christy said she and collaborators had previously identified a lack of Spanish-language materials about HPV vaccination for young adults, and found no materials culturally adapted for Hispanic and Latino sexual and gender minority community members. "To reduce HPV-related cancer disparities, it is essential that information be relevant and actionable and available to age-eligible people in their preferred language," said Christy.

In a study conducted between August 2021 and August 2022, Christy and colleagues sought to assess awareness about HPV and HPV-related cancers, as well as beliefs about HPV vaccination and risk, among young adult Spanish-speaking sexual minority men living in Florida and Puerto Rico. The goal of the study was to inform the development of an HPV vaccine education intervention to be tested in a future trial.

The study team administered a Spanish-language online survey to individuals between the ages of 18 and 26 who were born male and were living in Florida and Puerto Rico, all of whom identified as Hispanic or Latino, having had sex with a man or being attracted to men, and being able to read and understand Spanish. The results presented focused on 102 participants who said they had not received the HPV vaccine.

Fifty-six percent responded incorrectly or "do not know" to a question about whether most sexually active individuals are at risk for being infected with HPV, and 20% responded incorrectly or "do not know" to a question assessing whether men can be infected with HPV. Most respondents (69%) correctly identified that HPV can cause genital warts. However, more than half responded incorrectly or "do not know" to questions about the link between HPV and anal (54%), oral (61%), or penile (65%) cancers.

"There is still significant work to be done in raising public awareness around the link between HPV and HPV-related cancers, and about the fact that HPV is common and impacts people regardless of gender, biological sex assigned at birth, or sexual orientation. In addition, further efforts are needed to raise awareness about the efficacy of the HPV vaccine in protecting against the development of HPV-related cancers," Christy said.

Overall, 56% of respondents said they had heard of the HPV vaccine. However, only 19% said a provider had recommended it to them. "There are many adults who are age-eligible who have not yet received the HPV vaccine, have not had a provider recommend the HPV vaccine, and should be educated about HPV and the vaccine while they are still in the age range eligible for catch-up vaccination," Christy said.

Among respondents, nearly half reported being somewhat, very, or extremely concerned about cost being a barrier to receiving the HPV vaccine. Most participants (56%) reported they were either not at all or only a little concerned with the safety of the HPV vaccine; however, 25% responded they were very or extremely concerned.

"It is important that we as a research community consider the many factors that may currently get in the way of HPV vaccination among young adults and work to develop interventions to overcome these obstacles. This is especially important for community members who are disproportionately affected by HPV-related cancers," Christy said.

Current recommendations from the Centers for Disease Control and Prevention call for routine HPV vaccination for adolescents around ages 11 or 12. In addition, young adults up to age 26 are encouraged to be vaccinated if they did not receive the vaccine when they were younger. The U.S. Food and Drug Administration has approved the HPV vaccine for people ages 9-45. Christy said the results of this study serve as a reminder for young adults to be aware of their HPV vaccination history and to speak to a health care provider about getting the vaccine.

"Our study also points to the need for a call to action to providers to recommend the HPV vaccine. Prior studies have consistently shown the importance of provider recommendation in HPV vaccine receipt. However, most study participants reported that they had not received a provider recommendation to receive the vaccine. Importantly, many young adults do not have a regular health care provider, which is yet another barrier to overcome."

Christy said that among survey participants who had a primary care provider, less than half had disclosed their sexual orientation to their provider. She speculated that prior experiences of discrimination may limit patients' willingness to disclose their sexual orientation, and highlighted the importance of providers and systems ensuring that they are providing culturally relevant care.

"Our study was focused on Hispanic/Latino sexual minority men, but certainly there are many HPV-related disparities experienced by other sexual minority population groups as well as gender minority population groups. More research is needed to characterize HPV education needs and preferences among various young adult population groups and especially those groups for whom disparities exist," Christy said.

Christy cited the cross-sectional nature of this study and its focus on Florida and Puerto Rico as potential limitations.

This study was a pilot project led by Christy and Melissa Marzán-Rodríguez, DrPH, MPH, CPH.