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HPV vaccination among gay, bisexual and other men who have sex with men in Canada's three largest cities: a person-centred approach

  • Ramandip Grewal1
  • Shelley L Deeks2,3
  • Trevor A Hart2,4
  • Joseph Cox5,6
  • Alexandra De Pokomandy7
  • Troy Grennan8,9
  • Gilles Lambert6
  • David Moore9,10
  • Mark Gaspar2
  • Clemon George11
  • Jennifer Gillis12
  • Daniel Grace2
  • Jody Jollimore13
  • Nathan J Lachowsky10,14
  • Rosane Nisenbaum1,2
  • Gina Ogilvie8,9
  • Chantal Sauvageau15
  • Darrell HS Tan1,16
  • Anna Yeung1
  • Ann N Burchell1,2,17,*,

1St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada

2Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada

3Department of Health and Wellness, Halifax, NS B3J 2R8, Canada

4Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada

5Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC H3A 1Y7, Canada

6Direction régionale de santé publique, Montréal, QC H2L 2W5, Canada

7Department of Family Medicine, McGill University, Montréal, QC H3S 1Z1, Canada

8BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada

9Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada

10BC Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada

11Health, Nutrition, and Dietetics, SUNY Buffalo State University, Buffalo, NY 14222, USA

12Canadian Cancer Society, Vancouver, BC V5Z 4J4, Canada

13Community-Based Research Centre, Vancouver, BC V6Z 2H2, Canada

14School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada

15Institut national de santé publique du Québec, Québec, QC G1V 5B3, Canada

16Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada

17Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada

DOI: 10.22514/jomh.2023.097 Vol.19,Issue 10,October 2023 pp.22-33

Submitted: 23 March 2023 Accepted: 09 June 2023

Published: 30 October 2023

*Corresponding Author(s): Ann N Burchell E-mail:


Starting in 2015, many Canadian provinces and territories introduced publicly-funded human papillomavirus (HPV) vaccination programs targeted to gay, bisexual and other men who have sex with men (GBM) 9–26 years old. Using baseline data from the Engage study, a sexual health study of GBM from three Canadian cities, we explored how social and programmatic factors intersect and affect stages of HPV vaccination (Stage 1: unaware of HPV vaccine, Stage 2: undecided/unwilling to get vaccinated, Stage 3: willing to get vaccinated, Stage 4: vaccinated with at least one dose). First, by city, we created subgroups of GBM ≤26 years old (N Vancouver = 178; Toronto = 123; Montreal = 249) using latent class analysis. Next, by latent class, we estimated the probability of being in the four HPV vaccination stages using the Bolck, Croon and Hagenaar method. Latent class membership was associated with HPV vaccination stage in Vancouver (p = 0.003) and Montreal (p = 0.048) but not Toronto (p = 0.642). In Vancouver and Montreal, membership in the “no barriers” latent class had the highest probability of vaccination (56–58%). In Vancouver, the “racialized, GBM privacy, immigration and healthcare access barriers” class had a 75% probability of being vaccine unaware. In Montreal, the “immigration and past vaccines barriers” and “socio-economic, GBM privacy and healthcare access barriers” classes had the highest probabilities of being vaccine unaware (43% and 46%) and of being undecided or unwilling to get vaccinated (40% and 25%). In conclusion, our person-centred findings suggest tailored interventions by locale may help to increase HPV vaccine uptake among GBM in Canada’s three largest cities.


Vaccination; Human papillomavirus; Gay, bisexual and other men who have sex with men; Vaccine hesitancy

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Ramandip Grewal,Shelley L Deeks,Trevor A Hart,Joseph Cox,Alexandra De Pokomandy,Troy Grennan,Gilles Lambert,David Moore,Mark Gaspar,Clemon George,Jennifer Gillis,Daniel Grace,Jody Jollimore,Nathan J Lachowsky,Rosane Nisenbaum,Gina Ogilvie,Chantal Sauvageau,Darrell HS Tan,Anna Yeung,Ann N Burchell. HPV vaccination among gay, bisexual and other men who have sex with men in Canada's three largest cities: a person-centred approach. Journal of Men's Health. 2023. 19(10);22-33.


[1] Nyitray AG, Carvalho da Silva RJ, Baggio ML, Lu B, Smith D, Abrahamsen M, et al. Age-specific prevalence of and risk factors for anal human papillomavirus (HPV) among men who have sex with women and men who have sex with men: the HPV in men (HIM) study. The Journal of Infectious Diseases. 2011; 203: 49–57.

[2] Marra E, Lin C, Clifford GM. Type-specific anal human papillomavirus prevalence among men, according to sexual preference and HIV status: a systematic literature review and meta-analysis. The Journal of Infectious Diseases. 2019; 219: 590–598.

[3] Government of Canada. Human papillomavirus vaccine: Canadian immunization guide. Government of Ontario: Ottawa. 2017.

[4] Health Initiative for Men. GetGarded against HPV. 2015. Available at: (Accessed: 12 May 2023).

[5] Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, et al. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine. 2021; 39: 3756–3766.

[6] Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, et al. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada’s three largest cities. Human Vaccines & Immunotherapeutics. 2021; 17: 5413–5425.

[7] Marsh HW, Lüdtke O, Trautwein U, Morin AJS. Classical latent profile analysis of academic self-concept dimensions: synergy of person- and variable-centered approaches to theoretical models of self-concept. Structural Equation Modeling. 2009; 16: 191–225.

[8] Carter A, Lachowsky N, Forrest JI, Cui Z, Sereda P, Kaida A, et al. A latent class analysis of sexual and romantic relationships among HIV-positive and HIV-negative gay and bisexual men in Vancouver. The Canadian Journal of Human Sexuality. 2017; 26: 78–96.

[9] Card KG, Armstrong HL, Carter A, Cui Z, Wang L, Zhu J, et al. A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men. Culture, Culture, Health & Sexuality. 2018; 20: 1424–1439.

[10] Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, et al. Preferences across pre-exposure prophylaxis modalities among young men who have sex with men in the United States: a latent class analysis study. AIDS Patient Care and STDs. 2022; 36: 431–442.

[11] Traeger MW, Murphy D, Ryan KE, Asselin J, Cornelisse VJ, Wilkinson AL, et al. Latent class analysis of sexual behaviours and attitudes to sexually transmitted infections among gay and bisexual men using PrEP. AIDS and Behavior. 2022; 26: 1808–1820.

[12] Gilkey MB, Mohan D, Janssen EM, McRee AL, Kornides ML, Bridges JFP. Exploring variation in parental worries about HPV vaccination: a latent-class analysis. Human Vaccines & Immunotherapeutics. 2019; 15: 1745–1751.

[13] Hopfer S, Wright ME, Pellman H, Wasserman R, Fiks AG. HPV vaccine recommendation profiles among a national network of pediatric practitioners: understanding contributors to parental vaccine hesitancy and acceptance. Human Vaccines & Immunotherapeutics. 2019; 15: 1776–1783.

[14] Dudley MZ, Limaye RJ, Omer SB, O’Leary ST, Ellingson MK, Spina CI, et al. Latent class analysis of maternal vaccine attitudes and beliefs. Health Education & Behavior. 2020; 47: 765–781.

[15] Gravelle TB, Phillips JB, Reifler J, Scotto TJ. Estimating the size of “anti-vax” and vaccine hesitant populations in the US, UK, and Canada: comparative latent class modeling of vaccine attitudes. Human Vaccines & Immunotherapeutics. 2022; 18: 2008214.

[16] Lopez N, de la Cueva I, Taborga E, de Alba AF, Cabeza I, Raba RM, et al. HPV knowledge and vaccine acceptability: a survey-based study among parents of adolescents (KAPPAS study). Infectious Agents and Cancer. 2022; 17: 55.

[17] Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Social Problems. 1997; 44: 174–199.

[18] Hart TA, Moore DM, Noor SW, Lachowsky N, Grace D, Cox J, et al. Prevalence of HIV and sexually transmitted and blood-borne infections, and related preventive and risk behaviours, among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver: results from the engage study. Canadian Journal of Public Health. 2021; 112: 1020–1029.

[19] SAGE Working Group. Report of the SAGE Working Group on Vaccine Hesitancy. Geneva; date. 2014.

[20] Ontario Human Rights Commission. Policy and Guidelines on Racism and Discrimination. 2005.

[21] Lanza ST, Collins LM, Lemmon DR, Schafer JL. PROC LCA: a SAS procedure for latent class analysis. Structural Equation Modeling. 2007; 14: 671–694.

[22] Collins LM, Lanza ST. Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. 1st edn. Wiley: Hoboken. 2010.

[23] Lanza ST, Bray BC. Transitions in drug use among high-risk women: an application of latent class transition analysis. Advances and Applications in Statistical Sciences. 2010; 3: 203–235.

[24] Asparouhov T, Muthén B. Residual associations in latent class and latent transition analysis. Structural Equation Modeling. 2015; 22: 169–177.

[25] Volz EM, Heckathorn DD. Probability based estimation theory for respondent driven sampling. Journal of Official Statistics. 2008; 24: 79–97.

[26] Vermunt JK, Magidson J. Latent class analysis with sampling weights. Sociological Methods & Research. 2007; 36: 87–111.

[27] Dziak JJ, Bray BC, Zhang J, Zhang M, Lanza ST. Comparing the performance of improved classify-analyze approaches for distal outcomes in latent profile analysis. Methodology. 2016; 12: 107–116.

[28] Hamby S, Turner H, Finkelhor D. Financial Strain Index. Crimes Against Children Research Center: Durham. 2011.

[29] Lee JJ, Katz DA, Glick SN, Moreno C, Kerani RP. Immigrant status and sexual orientation disclosure: implications for HIV/STD prevention among men who have sex with men in Seattle, Washington. AIDS and Behavior. 2020; 24: 2819–2828.

[30] He Y, Dangerfield II DT, Fields EL, Dawkins MR, Turpin RE, Johnson D, et al. Health care access, health care utilisation and sexual orientation disclosure among Black sexual minority men in the Deep South. Sexual Health. 2020; 17: 421–428.

[31] Ogden SN, Scheffey KL, Blosnich JR, Dichter ME. “Do I feel safe revealing this information to you?”: patient perspectives on disclosing sexual orientation and gender identity in healthcare. Journal of American College Health. 2020; 68: 617–623.

[32] Turpin RE, Akré EL, Williams ND, Boekeloo BO, Fish JN. Differences in health care access and satisfaction across intersections of race/ethnicity and sexual identity. Academic Medicine. 2021; 96: 1592–1597.

[33] Musto R, Siever JE, Johnston JC, Seidel J, Rose MS, McNeil DA. Social equity in human papillomavirus vaccination: a natural experiment in Calgary Canada. BMC Public Health. 2013; 13: 640.

[34] Agénor M, Pérez AE, Peitzmeier SM, Borrero S. Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-affordable care act era. Ethnicity & Health. 2020; 25: 393–407.

[35] Rhee TG, Marottoli RA, Van Ness PH, Levy BR. Impact of perceived racism on healthcare access among older minority adults. American Journal of Preventive Medicine. 2019; 56: 580–585.

[36] Njoku A, Joseph M, Felix R. Changing the narrative: structural barriers and racial and ethnic Inequities in COVID-19 vaccination. International Journal of Environmental Research and Public Health. 2021; 18: 9904.

[37] Williams DR, Cooper LA. Reducing racial inequities in health: using what we already know to take action. International Journal of Environmental Research and Public Health. 2019; 16: 606.

[38] Rolnick SJ, Parker ED, Nordin JD, Hedblom BD, Wei F, Kerby T, et al. Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors? Vaccine. 2013; 31: 3928–3935.

[39] Niccolai LM, McBride V, Julian PR. Sources of information for assessing human papillomavirus vaccination history among young women. Vaccine. 2014; 32: 2945–2947.

[40] Thomas R, Higgins L, Ding L, Widdice LE, Chandler E, Kahn JA. Factors associated with HPV vaccine initiation, vaccine completion, and accuracy of self-reported vaccination status among 13- to 26-year-old men. American Journal of Men’s Health. 2018; 12: 819–827.

[41] Oliveira CR, Avni-Singer L, Badaro G, Sullivan EL, Sheth SS, Shapiro ED, et al. Feasibility and accuracy of a computer-assisted self-interviewing instrument to ascertain prior immunization with human papillomavirus vaccine by self-report: cross-sectional analysis. JMIR Medical Informatics. 2020; 8: e16487.

[42] Grace D, Gaspar M, Paquette R, Rosenes R, Burchell AN, Grennan T, et al. HIV-positive gay men’s knowledge and perceptions of human papillomavirus (HPV) and HPV vaccination: a qualitative study. PLOS ONE. 2018; 13: e0207953.

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