Michael G. Bare, MPH Program Coordinator National LGBT Cancer Network
The Human Papillomavirus (HPV) is the most common STI, and the cause of both lesions (warts) in the pelvic/ genital region, as well as the mouth. HPV has been found to be the cause of a variety of cancers. National Cancer Institute states that “high-risk HPVs cause virtually all cervical cancers. They also cause most anal cancers and some vaginal, vulvar, penile, and oropharyngeal cancers.”
The HPV vaccine was available for human use in 2006, and roll out campaigns aimed at youth have been the primary focus of the US public health service. In the US, the CDC suggests the HPV vaccine be given to all children 11-12 years old, teenagers who have not yet been vaccinated, for women up to age of 26 and for men up to age 21.
So what is the current uptake of the vaccine in LGBT communities? A study found that only about 31% of lesbians and bisexual women who were interviewed had completed the 3-shot course of the HPV vaccine, while about 14% had started but not completed the vaccine series; this is particularly concerning considering lesbians and bisexual women are less likely to get regular PAP tests which can lead to early detection, meaning any cancer diagnosis may come at a later stage in the illness. Rates for gay and bisexual men, and transgendered people are not available.
New research has shown that the HPV vaccine would be a good idea for adult gay and bisexual men, especially those living with HIV, which can increase the odds of cancer caused by HPV. For gay and bisexual men, HPV “is estimated to be present in 65% of gay men without HIV and 95% of those who are HIV positive. A simple and inexpensive anal Pap test detects the virus but, unfortunately, few physicians are performing anal screening exams and offering anal pap smears to gay men, resulting in anal cancer rates as high as those of cervical cancer BEFORE the use of routine Pap smears in women.” Activists in the UK are calling on the NHS to offer the vaccine to gay and bisexual men, calling current policies homophobic. Bisexuals, both men and women, have generally worse outcomes of most illnesses, compared to gay men and lesbians, and there is some evidence this extends to cancer. In our communities transgender folks may be uncomfortable, or cannot find a trans affirmative provider, who can perform necessary screenings such as prostate and rectal exams for trans women and chest and pelvic exams for trans men, which can also lead to late diagnosis and more invasive treatments.
While there is limited to no information on HPV vaccination rates for gay and bisexual men, or transgender persons, we recommend everyone seeking out the HPV vaccine from their provider. We also need better community messaging campaigns that bring information on this health issue to our community. The recent meningitis scare in LA and NYC has prompted public health officials to react, but HPV-related cancer will not have the same timing or geographical density for people to conceive an outbreak; these cancers will occur individually, across time: we need a similar high-yield campaign for HPV vaccines for the LGBT community.
To find out more check out information provided by the HPV and Anal Cancer Foundation. They do amazing work, and have resources and information that is priceless.