Human Papillomavirus Vaccination for Men

Advancing Policy and Practice

Peter A Newman; Ashley Lacombe-Duncan

Disclosures

Future Virology. 2014;9(12):1033-1047. 

In This Article

HPV Vaccine Acceptability for Men

Given the high efficacy and safety of HPV4 vaccination,[2] it is important to assess factors that contribute to low coverage among males. A number of investigations have addressed HPV vaccine acceptability, an integral component of uptake, for women. Consistent with the more recent licensure of HPV4 vaccination for men, fewer studies have assessed acceptability for men.[33] A descriptive review of HPV vaccine acceptability for men, published in 2010 immediately following licensure in the USA, importantly noted both the substantial influence of healthcare providers (HCP) on acceptability among males, and that HCP as well as parents were generally more supportive of HPV vaccination for girls than for boys.[34] A critical obstacle to HPV vaccine acceptability for boys was identified in that the general public largely equates HPV vaccination with cervical cancer; thus the HPV vaccine is understood as a women's vaccine.

Because HPV vaccination is most effective prior to sexual debut, it is important to understand barriers to HPV vaccine acceptability for males among parents, in addition to young men themselves. Results from a recent systematic review of 55 post-2009 articles that address barriers to HPV vaccination among US adolescents, including boys, indicate that parents were unclear about the need to vaccinate boys, perceived the consequences of HPV infection as less severe for boys or were unaware that the vaccine could be given to boys.[35] Parents were more likely to accept HPV4 vaccine if they perceived greater benefits for their sons or their sons' future female partners, if their family or friends had positive views about the vaccine or if the vaccine was recommended by a physician.[35]

A systematic review and meta-analysis (quantitative synthesis) of investigations assessing rates and correlates of HPV vaccine acceptability among males[33] revealed that HPV vaccine acceptability varied widely from 8.2–94.0%, with overall mean acceptability of 56.6 (standard deviation [SD]: 21.3) and a weighted mean acceptability of 50.4 (SD: 21.5).[33] Across 24 studies (n = 8360) that met inclusion criteria, half were from the USA, three Australia, two Sweden and one each from Canada, Germany, The Netherlands, New Zealand, The Philippines, Singapore and South Korea. Thus HPV vaccine acceptability for males remains moderate at best, with extensive variation across populations.

In the 16 studies (n = 5048) included in meta-analyses, correlates of HPV vaccine acceptability for men were identified in seven domains: HPV vaccine attitudes, HPV vaccine endorsements, HPV risk perceptions, behavioral risk indicators, HPV awareness, sociodemographic characteristics and structural barriers. Individual-level correlates of acceptability were greater HPV knowledge and awareness, higher perceived HPV risk and severity and greater perceived HPV vaccination benefits and perceived effectiveness.[33] Social–structural barriers to HPV vaccine acceptability for men included out-of-pocket cost and logistical obstacles (waiting time and hassle), while a supportive/accepting environment for HPV vaccination was a facilitator of acceptability.[33]

Overall, the factors with the greatest impact on acceptability for men were perceived HPV vaccine benefits for men and HCP recommendation. The impact of perceived HPV vaccine benefits for males is consistent with the finding that equating HPV vaccination with cervical cancer prevention may present a significant barrier to acceptability. The impact of HCP recommendation has been similarly identified as a significant correlate of HPV vaccine acceptability for girls[36] as well as acceptability of HBV vaccination overall.[37] Earlier research on factors associated with HCP implementing targeted HBV vaccination importantly implicate structural barriers, such as lack of government reimbursement and inadequate time to assess risk,[38] in addition to HCP knowledge and attitudes. In combination, structural barriers had a greater impact on HPV vaccine acceptability than HPV vaccine knowledge and effect sizes equal to behavioral risk factors, indicating the importance of government financing and policy in HPV4 vaccine acceptability for men.[33]

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