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HIV/AIDS, Sexually Transmitted Diseases,
Tuberculosis
Prevention News Update
Centers for Disease Control and Prevention
December 19, 2002
Medical News
Increasing Hepatitis
B Vaccination Among Young African-American Men Who Have Sex With Men:
Simple Answers and Difficult Solutions
AIDS Patient Care and STDs
11.02; Vol. 16; No. 11: P. 519-524; Scott D. Rhodes, Ph.D., M.P.H.;
Kenneth C. Hergenrather, Ph.D., M.R.C., M.S.Ed.; Leland J. Yee, M.P.H.
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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