Tempest in a teapot: A systematic review of HPV vaccination and risk compensation research

Abstract

There has been some concern among parents and in the media that vaccinating children against human papillomavirus could be seen as giving children permission to engage in risky sexual behaviors (also known as sexual disinhibition). Several studies have found this concern to be unfounded but there have been no attempts to synthesize the relevant studies in order to assess if there is evidence of sexual disinhibition. The aim of this study was to synthesize recent literature examining sexual behaviors and biological outcomes (e.g., sexually transmitted infections) post-HPV vaccination. We reviewed literature from January 1, 2008-June 30, 2015 using PubMed, CINAHL, and Embase with the following search terms: [(sex behavior OR sex behavior OR sexual) AND (human papillomavirus OR HPV) AND (vaccines OR vaccine OR vaccination)] followed by a cited reference search. We included studies that examined biological outcomes and reported behaviors post-vaccination in both males and females. Studies were reviewed by title and abstract and relevant studies were examined as full-text articles. We identified 2,503 articles and 20 were eventually included in the review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors or higher rates of STIs after HPV vaccination. Instead, the studies found that vaccinated compared to unvaccinated individuals were less likely to report vaginal intercourse without a condom (OR = 0.5; 95%CI = 0.4–0.6) and non-use of contraception (OR = 0.27; 95%CI = 0.15–0.48) and unvaccinated participants had higher rates of Chlamydia (OR = 2.3; 95%CI = 1.06–5.00). These results should be reassuring to parents and health care providers.

No evidence that HPV vaccination leads to sexual risk compensation

“…A decade since the licensure of the first HPV vaccine, its population-level effects look very promising, both in terms of efficiency 23 and safety. 24 Adding to this picture, the current review 20 shows that a considerable number of studies find no indication that HPV vaccination leads to sexual risk compensation, hence such concerns seem unwarranted.…”

“…Although 20 studies all point in the same direction, 20 there are still some issues left to address. First, more large-scale longitudinal studies are needed.…”

“…The current review 20 illustrates that risk compensation is not a universal feature of risk-reducing interventions. The relevance of risk compensation probably depends on the extent to which the intervention is perceived to reduce risk, which could be influenced by several factors.…”

“…In the current issue of Human Vaccines and Immunotherapeutics, Kasting et al 20 review the literature on HPV vaccination and sexual risk compensation. They identified 20 studies that examined sexual behaviors and/or biological outcomes after HPV vaccination.…”

Including males in Canadian human papillomavirus vaccination programs: a policy analysis

“…27,29,30 A ban of the HPV vaccine in some Catholic schools 31 may have suggested that receiving the HPV vaccine contributes to sexual disinhibition and related adverse outcomes (e.g., younger age at first intercourse, increased number of sexual partners and reduced use of contraception). 27,32 However, little evidence has been produced to substantiate these claims, 33 and Canadian parents rarely report these reasons as barriers to vaccination. 28 The media also contributes to influencing public opinion, and a number of sensational articles on the HPV vaccine have been published in Canadian media (e.g., a Toronto Star article that has since been retracted).…”