Association of Human Papillomavirus-Related Knowledge, Attitudes, and Beliefs With HIV Status

Infection with HIV increases risk of persistent human papillomavirus (HPV) infection and related diseases, including genital warts, cervical cancer, and anal cancer [1–3]. Men who have sex with men have markedly high rates of HPV-related disease including anal cancer, mainly attributable to the high prevalence of HPV infection [4–6] and HIV infection [7, 8]. The advent of highly active antiretroviral therapy has not reduced the high incidence of HPV-related cancers in HIV-infected individuals [9, 10]. Given gay men’s elevated risk for HPV-related diseases, primary prevention efforts such as HPV vaccination and secondary prevention strategies such as anal cancer screening may be particularly beneficial to them [11]. Since the approval of a quadrivalent HPV vaccine (HPV4) for females in 2006 [12], interest in expanding vaccine coverage to males has steadily increased [13–16]. In October 2009, the US Food and Drug Administration approved HPV4 for use by males aged 9 to 26 years [17], although off-label usage would permit men older than 26 years to receive the vaccine as well. Infection with HPV often happens soon after sexual debut, but it is unlikely that sexually active adult men have been exposed to all 4 HPV types present in the quadrivalent vaccine [18]. To understand the role that HIV status may play in HPV prevention efforts, we examined HPV-related knowledge, attitudes, and beliefs in a national sample of gay men.