Disclosure of Genital HPV Infection to Female Sex Partners by Young Men

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1 Disclosure of Genital HPV Infection to Female Sex Partners by Young Men Yuzo Arima, MPH, PhC HPV Research Group Department of Epidemiology, School of Public Health University of Washington Funding: National Institutes of Health (Grants 1R03HD and 1R01 CA ) Conflict of interest: None

2 Background Genital high-risk human papilloma virus (HR HPV) infection causes cervical cancer Population-based approaches to prevention of HPV infection and cervical cancer include promotion of behavioral risk-reduction strategies in both sexes Recent data suggest men are undergoing HPV testing in clinical settings, but little known about whether men who are diagnosed with HPV infection discuss their infections with their female partners

3 Background Disclosure to partner recommended for other STI s but not for HPV--risks and benefits of HPV disclosure largely unknown Developed a survey to assess extent of HR HPV disclosure by young men to their female partners, factors associated with disclosure, and consequences of disclosure

4 Objectives Identify correlates of disclosure of genital HR HPV infection by sexually active young men to their female sex partners Identify and describe outcomes of disclosure of genital HR HPV infection by sexually active young men to their female sex partners

5 Methods: Study Design Disclosure survey administered to 81 HR HPV+ male undergraduate students participating in longitudinal study Clinic visit every 4 mo, up to 3 yrs follow-up yrs at enrollment Healthy with history of sexual activity Informed consent and commit to 3-yr study HR HPV: 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82, IS39 uncertain cancer potential: 57, 62, 64/34, 67, 69, 71, 83, 84

6 Methods: Study Design Men who tested positive for incident HR HPV notified and asked to participate in survey at next visit 4 mo later Genital sample HR HPV- Genital sample HR HPV+ HR HPV+ result reported by clinician; HPV info, counseling provided Self-administered confidential online survey Period where subject potentially HR HPV+ but subject does not know Period where subject potentially HR HPV+ and subject knows

7 Methods: Survey Self-administered, confidential, online Questions adapted from recent HPV and STI disclosure surveys and pilot-tested Extent of HR HPV disclosure, correlates of disclosure, and outcomes of disclosure Assess at partnership level (up to 5 most recent partners in past year) Survey Jan Jan 2010

8 Methods: Analysis Relative Risk Regression (Generalized Linear Model, binomial family) Correlates of disclosure Subject level Partnership level Outcomes of disclosure Pap/HPV vaccine discussion Negative relationship change Adjusted for clustering in subject to account for correlation within subjects (i.e. >1 partnership data coming from same subject) Univariate and Multivariate

9 Results: Study Population 81 subjects with genital site testing positive for incident HR HPV completed survey contributing 264 partner-specific observations Median time to completion 5 min (range: 2-17 min) Race/ethnicity White: 203 (77%) Asian: 25 (10%) Other: 36 (14%) Mean age at time of HR HPV notification 2 years (SD: ) Median no. partners in previous year 3 (range: 1-9)* *only asked about 5 most recent partners

10 Results: Disclosure 81/264 disclosed (31% of partnerships) Right after notification: 43/81 (53%) Within 1 st wk of notification: 18/81 (22%) 1-2 wks after notification: 5/81 (6%) >2 wks to 1 mo after notification: 7/81 (9%) >1 mo after notification: 8/81 (10%)

11 Results: Disclosure Reasons Most common reasons for Disclosing (N=81) Wanted to be honest with her (90%) Felt it was right thing to do (89%) Cared about her (88%) Had strong emotional ties to her (75%) Most common reasons for NOT disclosing (N=183) Felt that using a condom was protective enough (34%) Not in a serious relationship with her (34%) Didn t know what to say (31%) Embarrassed to bring up the topic (27%) Didn t think disclosure was important (25%)

12 Univariate Results: Disclosure Disclosure (N=81) Nondisclosure (N=183) RR (95%CI) n (%) n (%) Partnership type Casual 16 (19.8) 147 (80.3) Main 64 (79.0) 36 (19.7) 6.5 ( ) Length of partnership (tertile) <2 wks 4 (4.9) 83 (45.4) 2 wks - 11 mo 18 (22.2) 62 (33.9) 4.9 ( ) >11 mo 53 (65.4) 25 (13.7) 14.8 ( )* Time of last sex (tertile) 2 wks ago 49 (60.5) 28 (15.3) 2 wks - 5 mo ago 15 (18.5) 68 (37.2) 0.3 ( ) >5 mo ago 12 (14.8) 77 (42.1) 0.2 ( )* period between date of first sex and last sex *Trend: p<0.001

13 Univariate Results: Disclosure Disclosure (N=81) Nondisclosure (N=183) RR (95%CI) n (%) n (%) Race/ethnicity White 66 (81.5) 137 (74.9) Asian 9 (11.1) 16 (8.7) 1.1 ( ) Other 6 (7.4) 30 (16.9) 0.5 ( ) Age at time of survey 19 years 6 (7.4) 15 (8.2) (23.5) 44 (24.0) 1.1 ( ) (29.6) 78 (42.6) 0.8 ( ) (33.3) 37 (20.2) 1.5 ( ) 23 5 (6.2) 9 (4.9) 1.3 ( ) Age 1 st vaginal intercourse <16 years 13 (16.1) 44 (24.0) (2) 35 (19.1) 1.4 ( ) (22.2) 72 (39.3) 0.9 ( ) (34.6) 24 (13.1) 2.4 ( ) >18 5 (6.2) 8 (4.4) 1.7 ( )

14 Univariate Results: Disclosure Disclosure (N=81) Nondisclosure (N=183) RR (95%CI) n (%) n (%) No. partners in past yr 1 34 (42.0) 11 (6.0) 2 28 (34.6) 30 (16.4) 0.6 ( ) 3 7 (8.6) 38 (20.8) 0.2 ( ) 4 3 (3.7) 28 (15.3) 0.1 ( ) 5 9 (11.1) 76 (41.5) 0.1 ( )* Concurrent partnership No 16 (36.4) 63 (38.9) Yes 28 (63.6) 99 (61.1) 1.1 ( ) among those with >1 partner *Trend: p<0.001

15 Multivariate Results: Disclosure Covariate Partnership type Casual Main Length of partnership (tertile) No. partners (continuous) Time of last sex (tertile) RR (95%CI) 2.1 ( ) 2.1 ( ) 0.9 (0.7-) 0.9 ( ) period between date of first sex and last sex

16 Multivariate Results: Discussion of Pap/HPV Vaccine Covariate Disclosure No Yes Partnership type Casual Main No. partners (continuous) RR (95%CI) 1.6 ( ) 6.0 ( ) 0.8 ( )

17 Multivariate Results: Worsened relationship Covariate Disclosure No Yes Partnership type Casual Main Time of last sex (tertile) Length of partnership (tertile) No. partners (continuous) RR (95%CI) 0.6 ( ) 0.7 (0.4-) 1.6 ( ) 1.1 ( ) 1.1 (-1.3)

18 Results: Partner response after disclosure (N=81) Partner response Supportive Worried Concerned Stressed Confused Embarrassed Consoling Shocked Blaming Angry Depressed Other response n (%) 53 (65) 34 (42) 33 (41) 18 (22) 17 (21) 12 (15) 10 (12) 5 (6) 5 (6) 4 (5) 2 (2) 15 (19) 74/81 (91%) disclosures did NOT lead to an argument

19 Limitations Sample size Generalizability Men who are getting tested voluntarily? Non-college students? Older men/married men? No validation of reported disclosure

20 Summary Disclosure of HR HPV infection to female partners by young men common among main (64%) and uncommon among casual partnerships (10%) Correlates of HR HPV disclosure Main partnership type Longer length of partnership Lower no. sex partners

21 Summary Disclosure reasons: common themes honesty, doing the right thing, caring, and emotional ties to partner Nondisclosure reasons: diverse themes condom was protective enough, not in a serious relationship, didn t know what to say, embarrassed to bring up topic, didn t think disclosure was important Outcomes of HR HPV disclosure More likely to discuss Pap/HPV vaccine Less likely to experience worsened relationship

22 Acknowledgements Rachel L Winer Qinghua Feng Michael E Stern Sandra F O Reilly Shu-Kuang Lee Nancy B Kiviat Laura A Koutsky Ann Kurth Diane Martin Jim Hughes Bita Amani Pamina Gorbach Linda Niccolai

Sources of repeat Chlamydia trachomatis infections:

Sources of repeat Chlamydia trachomatis infections: The importance of different sex partners revealed by a behavioral and molecular epidemiologic approach Linda M. Niccolai, PhD Associate Professor, Yale