Increasing Hepatitis B Vaccination Among Young African-American Men Who Have Sex With Men: Simple Answers and Difficult Solutions

Hepatitis B virus infection continues to be one of the most frequently reported preventable diseases in the United States, despite the licensure of a vaccine in 1982. Currently, an estimated 1.25 million individuals are chronically infected with HBV in the United States. HBV can be spread both parenterally and through sexual activity.

CDC and the US Gay and Lesbian Medical Association recommend vaccination against HBV for all men who have sex with men, a group among whom HBV has been identified as one of the most important STDs. However, available national epidemiologic data and results from community-based HBV vaccination programs indicate that the majority of MSM are not vaccinated. In this study, the authors identified correlates of vaccination against HBV among African-American MSM that could inform future interventions designed to enhance vaccination rates within this population. While the association of race with HBV incidence and prevalence presumably is a proxy for some other characteristic, understanding vaccination behavior among subgroups is essential to ensure that appropriately tailored, effective intervention strategies are designed and implemented.

During September 2001, the authors anonymously collected data in two predominantly African-American, male, gay bars in Birmingham, Ala. All bar patrons were asked to participate regardless of gender by one of four trained recruiters who explained the study and assessed sobriety of potential participants using established criteria to ensure informed consent. Questionnaires were self-administered and completed in secluded areas of bars. Items measured demographics, health insurance coverage, sexual and nonsexual risk behaviors, vaccination status, vaccine awareness, and resources used to obtain information about hepatitis.

Of the participants who completed the questionnaire, 170 self-identified as African-American or black and reported knowing their HBV vaccination status. The remaining participants self-identified as: white, Hispanic/Latino, or Native American; female; male and reported no same-sex sexual behavior within the past 5 years; or self-identified as male and reported same sex sexual behavior within the past five years but reported not knowing whether they had been vaccinated against HBV. Of the 170 participants, the mean age was 26.3 years. Nearly 40 percent reported being vaccinated against HBV while 21.8 percent reported never having heard of HBV. Over half of the participants reported 10 or more different lifetime male sexual partners, and fewer than half reported two or more different male sexual partners within the past 30 days. More than one-third reported having had sex with females as well as males within the past five years. Not including HIV seropositivity, nearly 11.2 percent of this sample reported a lifetime history of STD diagnosis, and 5.9 percent reported that they had received an STD diagnosis within the past 5 years. Approximately 7 percent of the sample reported receiving blood or blood products before 1992, and 4.7 percent reported ever having injected drugs or steroids; only two participants reported ever having shared injecting drug equipment.

Twelve characteristics -- including younger age, higher educational attainment, homosexual as opposed to bisexual behavior, and the timing of the most recent health care provider visit -- were associated with an increased likelihood of being vaccinated against the hepatitis B virus.

Understanding correlates of HBV vaccination among African-American MSM is not only crucial for the development and evaluation of tailored interventions aimed at increasing vaccination against HBV, but also provides the framework for developing future vaccination strategies for diseases such as HIV. Focus must be placed on increasing vaccination against HBV through innovative and well-tailored strategies, according to the authors. "A large majority of our sample reported engaging in behaviors that put them and their partners at risk for infection with HBV, yet we found many participants unaware of HBV and HBV vaccination," the researchers concluded.

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