Lesbians less likely to get HPV vaccine

NEW YORK - More awareness of the benefits of the human papillomavirus (HPV) vaccine and the risk of cervical cancer is called for in young women, particularly in lesbians who are much less likely to be vaccinated, according to researchers.

"Our research highlights the need for health care providers to recommend and provide the HPV vaccine to all of their adolescent and young adult patients, regardless of their sexual orientation," Dr. Madina Agenor, of the Harvard T.H. Chan School of Public Health, Boston, told Reuters Health by email.

"Our findings," she added, "also underscore the importance of implementing programs that educate young lesbians, as well as their caregivers and health care providers, about the risk of HPV transmission from female and male sexual partners and the need for HPV vaccination among lesbian girls and women."

In a May 11 online paper in Annals of Internal Medicine, Dr. Agenor and colleagues noted that lesbians in particular have limited knowledge of female-to-female HPV transmission and may not perceive messages about HPV and cervical cancer as being relevant.

The team used data from the National Survey of Family Growth on more than 12,000 women and girls to examine the association between sexual orientation identity and HPV vaccination.

Among the 3253 aged 15 to 25 years, 84.4% reported having heard of HPV vaccination. And of these, 28.5% had initiated vaccination. After adjustment, the prevalence of awareness was similar among heterosexual, bisexual, and lesbian respondents.

However, although 28.4% of the heterosexual women and 33.2% of the bisexual women had initiated HPV vaccination, this was true of only 8.5% of the lesbian group.

Part of the reason for this, the investigators wrote, is "the widespread misconception among lesbians and their health care providers that HPV cannot be transmitted through female-to-female sexual contact and that lesbians are not at risk for HPV from past sexual activity with men, in which most lesbians have engaged."

They add, "These misconceptions are fueled by lesbians' marginalization and invisibility in sexual health discourse and promotion efforts, which center on penile-vaginal sexual intercourse."

In light of these findings, the investigators conclude, "Programs should facilitate access to HPV vaccination services among young lesbians."

Commenting by email, Dr. Zoe Rodriguez of Mount Sinai Beth Israel, New York, told Reuters Health that she was happy that such research was being performed.

"As far as health disparities between heterosexual and lesbian women go, we've made strides," she said. "However, some of these barriers are self-induced due to concerns about possible discrimination and lack of confidentiality. Providers must find a way to obtain a thorough sexual history in a nonjudgmental way. Only then can we help patients make decisions regarding risk assessment and screening."

Dr. Rodriguez, who is vice chair of operations in the Department of Obstetrics & Gynecology, added, "It's interesting that although lesbians were aware of the HPV vaccine, only a small number initiated the series. Was it not strongly recommended by their provider?"

That, she concluded, is "a great start to a conversation about how we as gynecologic providers can do better to educate our patients about their risks for disease and work with them to formulate a plan of prevention and intervention when indicated."

SOURCE: http://bit.ly/1Pey5bA

Ann Intern Med 2015.

References: Reuters Health
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