Due to an increased risk of anal cancer and genital warts, the UK Joint Committee on Vaccination and Immunisation recommended targeted HPV vaccination programme for men who have sex with men (MSM). The research in this thesis aimed to examine the feasibility and acceptability of HPV vaccination for MSM in the United Kingdom. Accordingly, two systematic reviews and three empirical studies were conducted to address the thesis objective.
Two reviews synthesised evidence on factors associated with hepatitis A-B and HPV vaccine acceptability and uptake amongst MSM. The first study explored knowledge and beliefs about HPV and HPV-related diseases as well as attitudes towards the HPV vaccine amongst MSM in the UK, using qualitative methods. The second study examined psychological and behavioural factors associated with HPV vaccine acceptability amongst MSM, using quantitative methods. The third study investigated attitudes of sexual healthcare professionals (HCPs) towards a targeted HPV vaccination programme for MSM in the UK, using mixed methods.
The majority of MSM did not know about HPV and their risk of contracting genital warts and anal cancers. HPV infection was perceived as a female problem and HPV vaccination was thought to be against cervical cancer. While only 55% of MSM would be willing to ask for the HPV vaccine, 89% would accept it if offered by an HCP. Access to sexual health clinics, the disclosure of sexual orientation to an HCP and HIV-positive status were positively associated with HPV vaccine acceptability. Perceptions of HPV risk, HPV infection severity, HPV vaccination benefits, HPV vaccine effectiveness, and the lack of perceived barriers to HPV vaccination were also associated with acceptability. Around 14% of HCPs were already vaccinating men against HPV, 83% recommended gender-neutral HPV vaccination and 65% recommended targeting MSM.
Although nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. MSM need to be informed about HPV to appraise the benefits of HPV vaccination for their health. In order to achieve optimal uptake, vaccine promotion campaigns need to focus on MSM that do not access sexual health clinics and those unwilling to disclose their sexual orientation. Clear advice and guidelines on HPV vaccine use for men at sexual health clinic are required to ensure equitable opportunities for vaccination.
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