Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study

Abstract

Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

Cost and effectiveness of HPV vaccine delivery strategies: A systematic review

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Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006–2018

“… 23 Specifically, the lower HPV vaccination rate in Asian Indian women may relate to family influence because Asian Indian parents are less likely to encourage their daughters to get the HPV vaccine owing to stigma against sexual activities. 24 , 25 In addition, previous research has shown that Asian Indians are not as engaged in preventive healthcare as OA subgroups. 26 Acculturation and generation status can also influence HPV vaccine uptakes because studies have shown that first-generation immigrants are less accepting of the HPV vaccine than second-generation immigrants.…”

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