Falling Short of Clinical Recommendations: Low Uptake of the Human Papillomavirus Vaccine Among Gay, Bisexual, and Other Men Who Have Sex with Men in Ontario, Canada—Results from the Ontario Gay Men’s Health Survey

Introduction Despite the high prevalence of human papillomavirus (HPV) infection and incidence of associated anal cancer among men who have sex with men (MSM) and the recommendation that all MSM in Canada receive the HPV vaccine, uptake of the vaccine remains low. The objective of this study was to identify correlates of HPV vaccination among MSM to expose gaps and better inform vaccination strategies and policies. Methods Data were collected from an anonymous, online, self-administered survey of MSM in Ontario, Canada’s most populous province. Participants were recruited by network and snowball sampling from June 2018 to March 2019. Results Of 1788 survey respondents, only 27.3% reported having received the HPV vaccine. Those who were vaccinated tended to be ≤ 30 years of age, live in an urban center, have more sexual partners, and more frequently access sexual health services. Having a primary care provider was not associated with HPV vaccination. Conclusion These data mandate increased efforts to deliver the HPV vaccine to MSM. Policy Implications Our data suggest at least four areas for policy reform to help increase HPV vaccine uptake among MSM. First, public funding of the HPV vaccine should be aligned with clinical recommendations and the vaccine should be available free of charge to MSM irrespective of age. Second, sexual health clinics, as clinics of choice for sexual minorities, should be supported and the HPV vaccine should be bundled with other sexual health services. Third, innovative strategies should be developed and funded to better deliver the HPV vaccine to older MSM and those living in rural areas. Finally, policymakers must remember the MSM population is diverse, and data acquired from MSM living in large metropolitan centers should not be the sole source of information used to inform health policies for this population. More awareness of and data from men living outside urban settings is needed.