Factors Affecting Hepatitis Vaccination Refusal at a Sexually Transmitted Disease Clinic Among Men Who Have Sex With Men

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Abstract
Men who have sex with men (MSM) attending sexually transmitted disease (STD) clinics should be considered candidates for hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination. However, vaccination rates in STD clinics remain less than optimal. The goal was to identify factors that affect HAV and HBV vaccination refusals. A survey was administered to MSM eligible for the vaccinations attending an STD clinic. Vaccines were offered at the end of the clinic visit. Rates of refusal of HAV (RefuseA) and HBV (RefuseB) vaccinations were 36% and 38%. Health motivation was associated with acceptance, while clinical barriers such as “want to test first for immunity,” and “want to talk to own doctor first” were associated with refusal. “Not enough time this evening” was most strongly predictive of refusal, relative to strongly disagree (risk ratios [RRstrongly agree] and 95% confidence limits for RefuseA and RefuseB were 2.69 [1.43, 5.05] and 2.02 [1.05, 3.87], respectively). To increase acceptance, patients less health-motivated should be identified for prevaccination counseling. Some perceived barriers such as time may be a partial excuse; staff should identify and address other perceptions that may be influencing patients’ decisions.