Official advice for young gay New Zealanders to be given a free HPV vaccine is being echoed in the UK, where researchers say the argument for introducing targeted vaccination is strong. Like New Zealand, the UK has a vaccination programme against HPV, but only among girls, on the grounds that this will curb the spread of the infection to boys as well. Researchers from the Royal Liverpool University Hospital, Homerton University Hospital and Chelsea and Westminster Hospital, say gay men are more than 15 times as likely to develop genital cancer, particularly anal cancer, as a result of becoming infected with HPV, than straight men. They say that while rates of anal cancers are higher among men who are also HIV positive - despite antiretroviral treatment - they are also higher among gay men who have not been infected with HIV. The researchers add that data from Australia show that HPV vaccination of girls has had an impact on the prevalence of genital warts in straight men, but there has been no such change in prevalence among gay men. In February this year, Australia extended its school based HPV vaccination programme to 12-13 year old boys, with a catch up programme for 14-15 year olds. Recent research has shown that the HPV jab is effective in men, including gay men. The vaccine covers HPV 16 and 18, the two strains of the virus which account for most of the cancers associated with the infection. The vaccine is most effective in those who are not already infected with these strains of HPV, but the published evidence shows that only a minority of young gay men are, and that the strategy to vaccinate a group that includes those who have already been exposed to these strains is cost effective. The researchers say it’s not clear how effective it is to screen gay men, particularly those who are HIV positive, for signs of pre-cancerous tissue changes, so this wouldn’t be a viable alternative, say the authors, and would also preclude the introduction of universal screening. They say the argument for targeted vaccination is strong and sexual health clinics would be ideally placed to offer it, particularly as they already offer hepatitis B vaccination. In 2010, 17,000 gay men between the ages of 16 and 26 visited these clinics in England. The researchers argue that HPV vaccination would help prioritise initiatives to improve access to services for this group, who remain vulnerable to HIV infection. They admit that the biggest challenge will be to identify and vaccinate young gay men before they acquire HPV infection, but they point to recent data showing that vaccination of sexually active gay men is both clinically and cost effective. Here in New Zealand, the Pharmacology and Therapeutics Advisory Committee has received advice from health experts that males at greatest risk from the diseases are gay teens and young adults as they receive no "herd immunity" from contact with immunised females. Leading HIV and public health researcher Peter Saxton says all young men in New Zealand should be able to access the free vaccine. "There are serious health equity issues raised by having a vaccine that is this effective but not providing it to one of the highest need groups," Saxton says, "especially when gay men receive no indirect benefit through the vaccination of young women". "This is a cancer vaccine," he emphasises. "Any approach to covering gay men will have its imperfections but we shouldn't lose sight of the enormous public health benefits that are possible." Click here for the full UK study
Credit: GayNZ.com Daily News staff
First published: Wednesday, 17th July 2013 - 11:12am