Abstract
BackgroundHPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination.MethodsWe adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017.ResultsWe noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice.ConclusionsHPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.
Highlights
Human papillomavirus (HPV) vaccine is a prophylactic vaccine to prevent HPV infections
Recommended by the World Health Organization (WHO) [61], it is efficacious in the prevention of infections caused by cancerous HPV strains, which can lead to cervical cancer and precancerous cervical lesions, as well as those caused by non-cancerous HPV strains, which can lead to genital warts
HPV vaccination is suggested for women aged ≥9 years in Hong Kong [12]; we excluded women aged 9–17 years as children and adolescents within this age group are expected to be under parental influence and have limited autonomy in making decisions pertaining to vaccination
Summary
Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. Since licensure in 2006, HPV vaccines have been introduced for women in many countries and included in the immunization program of these places in order to prevent cervical cancer [40]. Few developing countries initially included HPV vaccines in their immunization programs considering the cost involved in vaccine delivery and competing public health priorities [25, 26]. As of 2016, HPV vaccine has been on the national or subnational immunization schedules in > 70 countries across continents [7]. The coverage rates between high-income and low- and middle-income regions have reversed in recent years, and the implementation of national HPV vaccination programs has allowed developing regions to achieve a higher vaccination coverage than developed regions on average [7]
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