1. National Immunization Conference Chicago March 17, 2003
Workshop 50
Session B8

2. Hepatitis A and B Vaccination among Men who Have Sex with Men (MSM)
Harold S. Levine
Levine & Co.

3. A Population at High Risk
Most U.S. hepatitis A outbreaks among adults (other than food-related) are among MSM
Consistently higher rates of hepatitis B infection
CDC recommends routine hepatitis A and hepatitis B vaccination for all MSM

4. MSM Population Estimate
6% to 8% of men between 18 and 54
4 to 5.5 million American men
15,000 to 20,000 per 1 million population
Urban concentration
Diverse sub-populations (age, income, residence, ethnicity)

5. MSM Population Estimates 6% of Men 24-54
Metro Market
Total Pop.
Est. MSM
New York
21,191,000
317,865
Los Angeles
16,373,000
245,595
Chicago
9,157,000
137,355
Washington, DC
7,608,000
114,120
San Francisco
7,039,000
105,585
Philadelphia
6,188,000
92,820
Boston
5,819,000
87,285
Detroit
5,456,000
81,840
Dallas/Ft. Worth
5,221,000
78,315
Houston
4,669,000
70,035

6. Findings from the GLMA 2002 National PrideFest Survey
Conducted at PrideFests, Summer 2002
4152 respondents nationally; approximately 150 per site
Self-selected respondents, more likely to be gay-identified, white
Obvious confusion between hepatitis A and hepatitis B

7. Less than half of respondents report receiving any doses of a vaccine against hepatitis A or hepatitis B.

8. Any Doses Hepatitis A or Hepatitis B Vaccine

9. There are wide variations in vaccination rates from city to city.

11. Strong Correlation Between A and B Vaccination
84% of respondents not vaccinated against hepatitis B not vaccinated for hepatitis B
76% of respondents not vaccinated against hepatitis A not vaccinated for hepatitis B

12. Many respondents who report vaccination may not be fully protected.

15. Healthcare Access Among Respondents is Relatively Good
80% have healthcare coverage
84% have a regular healthcare provider
70% of those respondents with a healthcare provider are “out” to that provider

16. Gay and Bisexual Men Seem to Access Healthcare Frequently
60% -- within last 6 months
80% -- within last 12 months
90% -- within last 2 years
(Atlanta and Seattle data)

17. Better healthcare = higher vaccination rates Poor access to healthcare = lower vaccination rates

21. 45% of the respondents have visited an STD clinic, but vaccination rates for MSM who have visited an STD clinic are only slightly higher than for those who never visited an STD clinic.

22. Vaccination Rate vs. STD Clinic Visit
Prior Infection, A or B
Prior Infection, A or B
Prior Infection, A or B

23. Fewer than one in 20 non-immune respondents has an appointment for vaccination

25. Provider recommendation is the single most important factor in hepatitis A and hepatitis B vaccination for MSM

26. What most influenced your decision to get vaccinated? (Seattle 2002)

27. Private Insurance Often Covers MSM Vaccination
75% of vaccinated respondents said insurance covered “all” or “part” of cost*
Varies from company to company, plan to plan
Claims must be coded correctly
Claims managers often need training
*1999 Four-City Survey

28. Private providers most likely source for future vaccination; clinics important for underserved; those not “out” to their provider

30. Out of pocket or Insurance Easy to reach Private Provider
Covered
Harder to Reach
Provider or Clinic
Out of pocket or Insurance
Easy to reach
Private Provider
Insurance or out of Pocket
Not “Out”
“Out”
Hardest to reach
Offsite/Mobile Unit
Needs free/low-cost vaccination
Easy to reach
Community Clinic
Needs free/low-cost vaccination
Not Covered

31. MSM Vaccination Goal Setting
Total population: 1 million
MSM population: 15,000
Non-immune: 7,500
10% goal for one year: 750
Split private providers/public health: 500/250 patients (1500/750 doses)

32. The Role of Public Health
Identify MSM seeking care through public health clinic system
Counsel regarding hepatitis A and hepatitis B risk and vaccination options
Integrate MSM hepatitis vaccination into clinic medical services

33. What Public Health Can Offer Private Providers
Advise regarding MSM vaccination recommendations
Educate regarding reimbursement options
Vaccinate patients who are not covered by insurance
Supply vaccine to providers serving MSM

34. Online Resources

35. Contact Information

36. Contact Information
Harold S. Levine
Levine & Co.
340 East 55th Street, 5D
New York, NY