Abstract 3327: HPV vaccination among adults at high-risk for HIV infection: A public health priority
Authors: Wigfall Lisa T. , Bynum Shalanda A. , Wells Jessica , McGee-Avila Jennifer K. , Wagle Nikita S. 
Published: August 2019

This study describes HPV vaccination rates among individuals who engaged in HIV infection high-risk behaviors (injection drugs and/or high-risk sexual behaviors) because HIV/HPV co-infection increases HPV-associated cancer risk.

Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey were used to describe HPV vaccination rates among HIV infection high-risk adults aged 18-36 years. We included: females aged 27-36 years for whom HPV vaccination was recommended in 2006; heterosexual males aged 23-29 years and gay/bisexual males aged 18-33 years for whom HPV vaccination was recommended in 2009. Stata/SE 15.1 was used to perform chi-square tests.

Of 486,303 adults who completed the 2016 BRFSS survey, only 3.39% (n=16,507/486,303) had used injection drugs and/or engaged in high-risk sexual behaviors. Among these 16,507 HIV infection high-risk adults, only 416 (2.52%) had complete data for all variables. About one fourth of gay/bisexual males aged 18-33 years had initiated the 3-dose HPV vaccine series (25.68%). Similarly, about one fourth of heterosexual females aged 18-36 years had completed the 3-dose HPV vaccine series (25.01%). Only 10.91% of heterosexual males aged 18-29 years had initiated the 3-dose HPV vaccine series. Age, sex, and sexual orientation differences in HPV vaccination rates were statistically significant (p=0.0047). All transgender men/women and gender-nonconforming individuals were unvaccinated (p=0.4138). While racial/ethnic differences in HPV vaccination rates were not statistically significant (p=0.0630), almost all non-Hispanic Blacks (96.09%) were unvaccinated. Although both HPV vaccine initiation (11.91%) and completion (15.72%) rates were higher among high-risk adults who had been tested for HIV, these differences were not statistically significant (p=0.0750).

In 2016, adult HPV vaccination recommendations included all females and gay/bisexual males aged 18-26 years, and heterosexual males aged 18-21 years. The Advisory Committee on Immunization Practices considers people living with HIV infection a special population of interest because of their increased HPV-associated cancer risk. That said, it was alarming that HPV vaccination rates were low among HIV infection high-risk adults in our study, including gay/bisexual males who have the highest HPV-associated cancer risk. For example, anal cancer risk among gay/bisexual males is exacerbated by HIV/HPV co-infection. Additionally, it was also alarming that almost all non-Hispanic Blacks in our study were unvaccinated, especially given the disproportionate burden of HIV/AIDS among this racial/ethnic minority group. Taking known HIV/AIDS and HPV-related cancer disparities among racial/ethnic and sexual/gender minority populations into account, it is essential that increasing HPV vaccination rates among unvaccinated HIV infection high-risk adults remain a public health priority.

Citation Format: Lisa T. Wigfall, Shalanda A. Bynum, Jessica Wells, Jennifer K. McGee-Avila, Nikita S. Wagle. HPV vaccination among adults at high-risk for HIV infection: A public health priority [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3327.