Black College Students, Especially Women, Delay HPV Vaccination

Brandon May

November 14, 2020

College students from minority communities and communities of color are less likely to receive the human papillomavirus (HPV) vaccine compared with individuals in the White community, with Black women significantly less likely than Black men to plan to receive the vaccination, according to results from a small study presented at the Association of Nurses in AIDS Care Virtual Conference.

Lead author Kayla Mathis-Gamble, PhD, MSN, APRN-BC, of the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, said the findings were surprising considering the female population has been targeted for years with education on preventing sexually transmitted infections (STIs).

In spite of the gender differences, educational initiatives for HPV vaccination and prevention are sorely lacking for both male and female Black college students. "Educational programs on HPV and the importance of HPV vaccination for both men and women need to be implemented on college campuses," Mathis-Gamble said during her presentation.

Awareness of HPV Vaccination Lacking Among Minority College Students

Data from the Centers for Disease Control and Prevention indicate HPV disproportionally affects Black women and gay men. Many Black parents, however, are hesitant to vaccinate their children for HPV and perceive HPV vaccination as unnecessary for boys.

Researchers from Broward College and Florida International investigated whether non–HPV-vaccinated Black college students are aware that the vaccine can be administered at student health services centers on campus.

Mathis-Gamble and colleagues recruited 152 students from four historically Black colleges/universities: a rural setting in Alabama and three others located in urban settings in Florida. In this sample, only 30.3% (n = 47) of students said they intended to receive the HPV vaccine.

Overall, students had a moderate amount of sexual experience as dictated by a mean score of 10.4 on the Sexual Experiences Questionnaire (SEQ). Students also demonstrated low risk-taking behaviors, as suggested by the mean score of 7.8 on the Sexual Risk Survey (SRS). A binomial logistic regression analysis found no significant interaction between gender and sexual behavior with the intent to vaccinate.

Gender alone, however, was significantly associated with intent to receive the HPV vaccine, with women significantly less likely than men to plan to seek vaccination (odds ratio, 0.437; P = .032).

Factors Driving Disparities in HPV Vaccine Uptake

When asked about the most predominant factors that lead to disparities between the Black and White communities in terms of HPV vaccine uptake, Mathis-Gamble cited the "taboo" nature of HPV, resulting in a lack of discourse about virus prevention between Black parents and their children.

The lack of culturally tailored health education may also be a factor. Session moderator Marik Moen, PhD, MPH, RN, Department of Family and Community Health, University of Maryland School of Nursing, College Park, told Medscape Medical News in an email that people in circumstances of discrimination, poverty, and other social determinants of health may often feel that certain messages aren't relevant for them because these messages aren't tailored to their cultural/social context.

"Moreover, communities of color, and in the context here, young Black men and women, have so many legitimate reasons not to trust information and vaccines offered by the healthcare system due to past unethical treatment and experimentation," added Moen, whose research specialties include STIs and social determinants of health. She suggests minority communities may also perceive ongoing differential treatment based on healthcare providers' biases, further contributing to a healthcare system that is — or seems — not especially inclusive.

What Can Be Done to Reduce Disparities?

"I think these factors could be addressed on a grassroots level," said Mathis-Gamble. "A lot of times we just don't take that initiative to really get in with the population and see what their thoughts are and what they feel they need to be successful."

Integrating measures to improve HPV uptake in the Black community requires greater navigation of services plus increased support to address unmet basic needs, including housing, income, and transportation, Moen said.

In Moen's own research, having basic needs met was significantly protective of sexual risks compared with individuals with unmet basic needs (J Urban Health. 2020;97: 395-405). "I don't know if that could be extrapolated to say that having more basic needs met leads to increasing protective health behaviors like uptake of HPV vaccine," she said, "but it could help."

In addition to addressing social determinants of health and basic needs, Moen added that more work is needed to foster greater trust among healthcare providers and underserved communities. "To develop sufficient and trustful relationships in order to convey the right messages and facilitate equitable access and uptake is therefore a higher hurdle to cross," she concluded.

Mathis-Gamble and Moen have disclosed no relevant financial relationships.

Association of Nurses in AIDS Care (ANAC) 2020 Virtual Conference:
Abstract 11. Presented November 12, 2020.

Brandon May is a freelance medical journalist who has also written for ASCO Daily News, CenterWatch Weekly, and Oncology Times. He resides in Brooklyn, New York. He can be reached on Twitter @brandonmilesmay.

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