Examining Sexual Orientation Differences in the Utilization of the Human Papillomavirus Vaccine, Human Papillomavirus Test, and Cervical Papanicolaou Test in Allegheny County, Pennsylvania

Abstract

Despite sexual minorities' (SMs) increased risk for contracting human papillomavirus (HPV) and developing related cancers compared to their heterosexual peers, we know little about SM disparities in uptake of HPV vaccines and routine screenings. Therefore, this study examined sexuality differences in HPV preventive interventions and related screenings. From 2015 to 2016, Pennsylvania's Allegheny County Health Department commissioned a health survey of 9,026 adults in their catchment area using probability-based sampling. Multivariable models tested differences by sexual identity separately for cisgender men and women (heterosexual versus gay/lesbian, bisexual, and other) for lifetime receipt of HPV vaccine and number of HPV vaccines. Among women, we examined sexuality differences in HPV and cervical Pap tests, adjusting for age, race/ethnicity, education, marital status, and income. No differences in prevention utilization emerged when comparing heterosexual women to all SM women. However, exploratory analyses comparing heterosexual women to subgroups of SM women found lesbians had higher odds (adjusted odds ratio [AOR] = 5.27; 95% confidence interval [CI] = 1.15–24.09) of never receiving an HPV vaccine. Women who reported their sexuality as “other” had higher odds (AOR = 5.65; 95% CI = 1.03–31.02) of never receiving a cervical Pap test compared to heterosexual women. “Other” women had higher odds (AOR = 19.80; 95% CI = 1.64–239.16) of never receiving a cervical Pap test when compared to heterosexual women receiving one within the recommended screening guidelines. SM men's utilization was not significantly different from heterosexual men, though vaccination uptake for both groups was low. These findings highlight the need for additional public health surveillance to understand cancer prevention utilization among this underserved population.