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New studies find that LGBTQ-affirming health care settings, combined with recommendations from providers, can increase uptake of Hepatitis A & B vaccines among LGBTQ people

A black doctor giving a vaccine to a non-binary young

BOSTON, MARCH 4, 2024—A new policy brief published today by Fenway Health and MPact Global Action finds that gay, bisexual, and men who have sex with men and transgender and nonbinary people at high risk of infection with Hepatitis A & B possess significant knowledge of Hepatitis A & B and are open to receiving Hepatitis A & B vaccinations. But negative experiences in healthcare settings, and other barriers to health care access can prevent them from obtaining vaccines or vaccine boosters. A second policy brief found that even though many providers perceive that their patients have a low baseline knowledge of Hepatitis A & B, they often only bring up discussion of Hepatitis A & B in the context of childhood vaccines. Findings of both studies suggest that increased provider education about Hepatitis A & B, and culturally responsive vaccine clinics may increase rates of Hepatitis A & B vaccination among gay and bisexual men and transgender people.

“Hepatitis A & B are serious infections that cause inflammation of the liver. Both can be prevented by vaccines. Given that rates of Hepatitis A infection have increased sharply in the last decade and that rates of Hep A&B are disproportionately high among gay and bisexual men and transgender women, it is imperative that we find ways to increase rates of vaccination,” said Sean Cahill, PhD, Director of Health Policy at The Fenway Institute and lead author of “Scaling up Hepatitis A and B vaccination for gay and bisexual men and transgender people” and “Providers’ perspectives on Hepatitis A and B vaccination for gay and bisexual men and transgender people.”

Study methodology

Researchers conducted four online focus groups in English and Spanish with 22 gay and bisexual men and other men who have sex with men from Mexico and the United States. Participants ranged in age from 23 to 62 and over 75 percent (17) identified as Black, Indigenous or other people of color (BIPOC). Two online focus groups were held with 22 transgender and gender diverse people from the United States and one from Mexico. Participants ranged in age from 23 to 55. Most held multiple gender identities and over 75 percent (18) identified as BIPOC. Two online focus groups were held with eight providers from the United States who ranged in age from 30 to 46. Two providers identified as Asian while the rest identified as White or did not specify their race. The online focus groups were conducted by InsideHeads, and the study was funded by GlaxoSmithKline, which manufactures Hepatitis A&B vaccines.

Key findings

High awareness of Hepatitis among LGBTQ community members: Focus group participants displayed significant knowledge of Hepatitis. They knew that Hepatitis is a liver disease, that there are at least three varieties of Hepatitis (A, B and C), and that they are sometimes transmitted sexually, sometimes by sharing needles, and in other ways.

Providers underestimate patients’ awareness of Hepatitis: Providers commented that they have low confidence in their patients being knowledgeable about Hepatitis.

Both providers and LGBTQ community members say that LGBTQ people are open to vaccines: Virtually all participants were open to Hepatitis vaccination and expressed intent to be vaccinated if presented the option. Many said they were already vaccinated against Hepatitis at an early age. Providers said that most patients tend to be very accepting of vaccines and are largely unconcerned about Hepatitis, so have little to no issue with being vaccinated.

Both LGBTQ community members and providers talked about barriers to health care as important reasons for low Hepatitis A&B vaccination rates, but emphasized different types of barriers. LGBTQ community members focused on fear of stigma due to prior negative experiences in health care settings as a primary reason for low vaccination rates, while providers emphasized structural barriers to accessing healthcare as the primary reason for low vaccination rates. LGBTQ focus group participants noted feeling a lack of comfort and empathy in medical spaces, and some reported experiences in which they felt they were treated differently or judged by their providers due to the stigma surrounding their sexual orientation, diverse gender identities, and/or sexual practices. Providers discussed how institutional and structural barriers to healthcare access were significant reasons for people being unvaccinated. These barriers include lack of proper transportation, inability to make appointments, and financial constraints, such as lack of health insurance. Additionally, providers spoke about how certain demographic characteristics like undocumented status, race/ethnicity, and gender can impact access to vaccines.

“All queer people have a right to quality healthcare. Structural homophobia and stimga in healthcare settings must be meaningfully addressed to ensure queer communities can benefit from vaccinations. Vaccine justice is essential and must be prioritized by the LGBTQ community and health providers,” said Alex Garner, Director of Community Engagement at MPact Global and co-author.

“Many of our focus group participants described interactions with health care providers that were judgmental and even voyeuristic,” said Jonathan Hill-Rorie, MPH, and co-author of both studies. “At the same time, many gay and bisexual men and transgender people are open to getting vaccinated against Hepatitis infection. If we can address the structural and institutional barriers to care and leverage the positive attitudes LGBTQ people have toward vaccines, we have a real opportunity to improve health outcomes and protect gay and bisexual men and transgender people against Hepatitis A and B.”

“Scaling up Hepatitis A and B vaccination for gay and bisexual men and transgender people” and “Providers’ perspectives on Hepatitis A and B vaccination for gay and bisexual men and transgender people” are available online here: https://fenwayhealth.org/hepatitisA&B/

About Fenway Health & The Fenway Institute

Since 1971, Fenway Health has been working to make life healthier for the people in our neighborhoods, the LGBTQ community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues.

About MPact: Global Action

MPact: Global Action is a catalyst for creating change among global gay, bisexual, and gender diverse communities. It was founded in 2006 as the Global Forum on MSM and HIV by an international group of activists who were concerned about the disproportionate burden being shouldered by gay and bisexual men in the HIV epidemic.

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