HPV vaccination for men who have sex with men – too little too late?
The Department of Health and Social Care will this year start rolling out a national HPV vaccination programme aimed at men who have sex with men (MSM). This will bring England into line with Scotland, Wales and Northern Ireland, which already have national programmes for MSM.
The rationale for a specific programme for MSM is that, unlike heterosexual men, they derive no benefit from the vaccination of girls and are therefore at particular risk. There is some truth in this, which is why the rollout is welcome, but there are also serious doubts about whether the MSM programme constitutes an effective response.
- The programme is delivered opportunistically to MSM aged up to 45 years via sexual health clinics. Following big cuts in funding across the country, many clinics may well lack the capacity to offer an effective HPV vaccination service.
- The average age of first attendance for MSM is 32 years and a recent study of MSM attending a London sexual health clinic found that 45% had a current HPV infection with a type that can cause cancer or anogenital warts. A significant proportion of MSM will therefore already have been infected before they are offered HPV vaccination.
- A proportion of MSM attending clinics will be unable to access vaccination because they will choose not to disclose their sexual identity.
- The number of MSM is almost certainly increasing as a result of what has become known as ‘sexual fluidity’. Men who define themselves as heterosexual may have sex with other men occasionally or regularly, behaviour that increases their risk of exposure to HPV infection.
- The evaluation of the MSM vaccination pilot programme showed that, out of almost 19 000 MSM attending a clinic, just 46% were recorded as actually receiving the first of three vaccine doses. There is no good data on the numbers who went on to receive the required second or third doses. 50% of those recorded as receiving the first dose were aged 31–45. The evaluation did not look at the impact of vaccination on health outcomes. It is therefore difficult to agree with the DHSC’s statement that the pilot was ‘a success’.
The best way to protect MSM is to vaccinate in adolescence, before sexual contact and therefore before exposure to HPV. Questioning boys in this age group about their sexual orientation would be impractical (because orientation for many will not yet be firmly established) as well as unethical, and it would almost certainly be opposed by parents and boys themselves. The only effective solution is therefore to vaccinate all boys in order to reduce the risks to men whatever their sexual orientation.
However, the government’s vaccination advisory committee (JCVI) has been considering the vaccination of boys since 2013 and has not set a date for its decision. With each year that passes, around 400 000 more boys are left unprotected against HPV and the diseases it can cause, including penile, anal, head and neck cancers as well as genital warts.
What do you think? Is this another example of men’s health being short changed?