Abstract
The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Gay, bisexual, and other men who have sex with men (GBM) living with HIV are disproportionately impacted by HPV-associated anal cancer, with rates about 100-fold that of the general population. Fortunately, HPV vaccination has proven efficacy in preventing both anogenital warts (condyloma) in males and anal pre-cancers (anal intraepithelial neoplasia; AIN) in GBM up to the age of 26. We conducted in-depth, semi-structured interviews with 25 HIV-positive gay men in Toronto to gain an understanding of their knowledge and experiences related to HPV and the HPV vaccine. These participants were part of The HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, and received invitations to have anal cancer screening from their primary care doctors. Interviews were analyzed following a Grounded Theory Approach. Most participants had not received the HPV vaccine. Men described a lack of prior knowledge of the health consequences of HPV for GBM living with HIV and financial barriers to vaccine access. Participants did not articulate concerns about vaccine safety. Men frequently reported initial beliefs that HPV was predominantly—or exclusively—a risk for females or young girls, and thus they had not considered the vaccine to be necessary. Some participants remained uncertain if the current availability of the vaccine, and their newly acquired knowledge of its importance, was “too little, too late” because of their age and/or HPV exposure. Improving access and uptake of HPV vaccination requires addressing both financial barriers to access as well as increasing HPV health literacy levels, particularly by reframing the long-standing gendered associations of HPV. Physicians should provide clear, tailored messages regarding HPV vaccination.
Highlights
ObjectivesOur objective was to inductively examine participants’ narrative accounts of their knowledge, experiences, and perceptions related to Human Papillomavirus (HPV) and the HPV vaccine in order to understand the production and organization of HPV health literacy and vaccine uptake
The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is a cause of anogenital cancers [1]
The following key domains were explored: (1) general awareness and understanding of Human Papillomavirus (HPV) and anal cancer risks; (2) social and cultural contexts informing HPV and sexual health related decision-making; (3) motivations and experiences related to anal cancer screening; (4) other anal and gastrointestinal disease and STI treatment experiences; and (5) knowledge, perceptions and experiences related to the HPV vaccine. While this last interview domain is the primary focus of the analysis presented in this paper, we draw upon the interviews in their entirety given that in most instances the HPV vaccine was discussed by participants earlier on in the interview and connected to other key interview questions, including men’s HPV knowledge and anal cancer screening motivations
Summary
Our objective was to inductively examine participants’ narrative accounts of their knowledge, experiences, and perceptions related to HPV and the HPV vaccine in order to understand the production and organization of HPV health literacy and vaccine uptake
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