(P158) Syndemic Profiles of Human Papillomavirus (HPV) Infection in United States Adults

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States; over 80% of the population will become infected with HPV in their lifetime. From 2013-2016, an estimated 42 million people were positive for HPV strains associated with increased risk of cancers. Syndemic factors, synergistic co-occurrence of social and disease conditions, may influence HPV risk and severity but have not been explored. Syndemic approaches are aligned with the National Academy of Medicine’s strategic plan to reduce STIs in the United States. Therefore, this study identified syndemics of HPV in a nationally representative sample of US adults.

Methods: Data were from 6,004 participants ages 18-59 in the NHANES 2013-2014 and 2015-2016 cycles who had both HPV serologic and DNA typing results and reported on substance use, mental health, sexual behavior, and other behavioral and lifestyle characteristics. A Latent Class Analysis (LCA), stratified by race/ethnicity and gender, was used to identify clusters of similar response patterns from participants to create risk profiles (i.e., unobserved latent classes) using variables of interest.

Results: Females in the syndemic HPV class indicated higher probabilities of oral sex (99%) and anal sex (63%), same sex partners (15%), older partners (19%), having another STI (25%) during the study period, substance use (marijuana 92%; other drugs 33%; alcohol 17%, tobacco 27%), greater than two partners in the past year (42%), and were more likely to be HPV positive (58%). Females in the syndemic class were more likely to be lower income (OR=1.43 CI 95% 1.05-1.93), younger (OR=1.20 CI 95% 1.04-1.38), Black race (OR=1.48 CI 95% 1.09-2.01) and have less than high school education (OR=2.72 CI 95% 1.91-3.38). HPV syndemic males had the highest probability of indicating oral sex (100%), anal sex (74%), same sex partners (40%), and testing positive for other STIs (22%) during the study period. Syndemic class males were at increased odds of having less than high school education (OR=1.60 CI 95% 1.01-2.53).

Conclusion: Continued evaluations of potential correlates and predictors of HPV could further identify actionable areas for intervention to continue to reduce rates in US adults.