HPV Vaccination Among LGBTQ Community in the U.S.: What Is the Evidence?

Background: Human Papillomavirus (HPV) infection has become a leading cause of cervical and penile cancers by which people suffer from long-term mental and physical distress and shoulder financial burdens for treatment. Moreover, the LGBTQ (lesbian, gay, bisexual, transgender, and queer) community is disproportionately impacted by HPV and HPV-related cancers in the U.S. Even worse, as a primary prevention method, the acceptance, initiation, and completion of HPV vaccine are much lower among LGBTQ community. This study is to review quantitative and qualitative studies on HPV vaccination for LGBTQ community to identify facilitators and barriers of HPV vaccine acceptance, initiation, and completion among LGBTQ community.

Methods: Searching was conducted among PubMed, Web of Science, PsycINFO, and CINAHL from 2010 to 2020 in the U.S. Results reported in the included studies were coded into two categories: facilitators and barriers. Facilitators and barriers were identified and coded focusing on a.) HPV vaccine acceptance, b.) HPV vaccine initiation, and c.) HPV vaccine completion among LGBTQ community. According to Cochran’s quality of evidence guideline, the included quantitative studies were assessed with the following potential biases for low risk, moderate risk, and high risk: selection biases, performance biases, detection biases, attrition biases, and reporting biases. The included qualitative studies’ trustworthiness was assessed with the following potential threats for low risk, moderate risk, and high risk: credibility, transferability, dependability, and confirmability.

Results: The present review identified 26 studies that met the inclusion criteria conducted from 2010 to 2020 in the U.S. Among these studies, there were 21 studies of men who have sex with men (MSM), 12 studies of bisexual men & bisexual women, 7 studies of women who have sex with women (WSW), 4 studies of transgender and queer. There were 21 quantitative studies among which most of the studies had a low risk of bias (n= 13), the remainder studies had a moderate risk of bias (n= 8). There were 5 qualitative studies that all had a low risk of bias. Results also showed that knowledge of HPV, knowledge of HPV vaccine, and recommendations from the healthcare providers are highly reported facilitators. For barriers, lack of knowledge of HPV vaccine, high co-pay cost, and concerns of the effectiveness and safety of HPV vaccine are highly reported.

Conclusion: Enhancing and improving HPV-related and HPV vaccine-related education and follow-up education to LGBTQ community are essential, especially for those who have lower education levels. Besides, professional training for healthcare providers to improve their cognition of HPV-related and HPV vaccine-related knowledge is necessary so that effective education and recommendations can be offered to facilitate LGBTQ community to complete all 3-dose HPV vaccine. Health insurance coverage also needs to be expanded to benefit more people from LGBTQ community to release their financial burden in direct medical costs to provide more access to HPV-related healthcare.