• 10
    Feb
  • HEPATITIS A VACCINATION AMONG YOUNG AFRICAN AMERICAN MEN: DISCUSSION

vaccination

Enhancing awareness and facilitating vaccination among populations at risk for HAV infection are urgently needed. About a third of this sample was vaccinated, and another third reported knowing nothing about hepatitis. Furthermore, many participants reported engaging in behaviors that put them and their sexual partners at risk for hepatitis A infection. The low level of vaccination and the high levels of risk behaviors, such as inconsistent condom use and anal-oral contact (“rimming”), suggest that the failure to vaccinate this high-risk population is a missed opportunity to prevent disease.

Within this sample of African American MSM, lower scores for perceived practical barriers to HAV vaccination were associated with HAV vaccination. Thus, interventions to increase vaccination among unvaccinated MSM may focus on increasing knowledge about hepatitis A infection and HAV vaccination, identifying convenient locations for vaccination administration, and reducing the out-of-pocket expense of vaccination against HAV Furthermore, this study, like studies with samples of predominately white MSM exploring predictors of hepatitis В vaccination, found an association between vaccination and health care provider communication about patient sexual orientation and risk. Thus, to increase HAV vaccination among African American MSM, strategies must be developed to facilitate increased provider communication with patients to ensure patient disclosure of risk and accurate risk assessment. Because recommendation by a health care provider is a strong predictor of preventive behavior, providers must inform patients about the efficacy and safety of the vaccine to encourage vaccination among MSM. Environments must be created that build trust and allow risk disclosure. Some providers are beginning to experiment with delivering patient education and interactive risk assessment through computer technology. Such applications may provide “cues for action” for patients to either discuss risks with or seek vaccination from their health care providers.
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Interestingly, the perceived benefits of vaccination were not associated with HAV vaccination. This finding may reflect “AIDS fatigue,” a phenomenon in which MSM become weary of HTV and AIDS messages through overexposure. This phenomenon has been linked with decreased attention and adherence to HBV vaccination messages. Innovative, sex-positive vaccination promotion efforts may be key to increasing rates of HAV vaccination among MSM.

Perceived personal self-efficacy, which in this case can be defined as one’s judgment of one’s capacity to become vaccinated against HAY was also found to be predictive of vaccination status in the multivariable model. Participants who reported more confidence in overcoming embarrassment of talking about their sexual behavior with providers, overcoming worries about HAV vaccine safety and rumored side effects, and overcoming concerns such as time and money were seven times more likely to report HAV vaccination than those who reported less confidence in overcoming these concerns. Thus, intervention strategies must include components that focus on increasing the self-efficacy of unvaccinated African American MSM. Lay health advisory networks or well-tailored communication campaigns may encourage vaccination against HAV through peer leaders or role modeling. The peer leader approach has been shown to be successful in HIV prevention intervention design among MSM, and could be tested empirically for the promotion of HAV vaccination. Role modeling through multimedia communication campaigns also has been found efficacious with HIV prevention efforts and also may inform strategies to increases HAV vaccination among African American MSM.

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