While awareness about HPV has increased over the past decade, understanding about HPV, how it is diagnosed and treated, and its link to cervical cancer remains low.52, 53, 56 Common barriers to HPV vaccination, in general, fall into 3 broad categories: 1) lack of knowledge about the vaccine or target disease, 2) problems of access to medical care, and 3) fears about vaccine safety. Vaccine efficacy, physician endorsement, and cost have shown to be important predictors of vaccine acceptability. Results emphasize the importance of
informing and training healthcare providers about the vaccines and about the contribution of provider recommendations to decision making about health.55 Moreover while most family physicians are aware of new information about human papillomavirus, including new DNA tests and a prophylactic vaccine, many remain unaware of information that may influence counseling messages and clinical management of HPV-related conditions.69
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the literature confirmed the dearth of knowledge about HPV among the general population, specifically among young adult women. The development of appropriate and effective HPV communications must be based on an in-depth understanding of the target audience’s current knowledge, attitudes, perceptions, and beliefs about HPV as well as their information needs and communication preferences.54
Significant and sustained public education efforts designed to raise awareness about HPV and the benefits of HPV immunization will become necessary to ensure the wide use and successful implementation of the HPV vaccine. To be effective, HPV immunization initiatives aimed at young adults should provide accurate information about HPV infection and its link to cervical cancer and genital warts; should emphasize efficacy, safety and benefits of vaccination; and should assess normative beliefs about vaccination.
Furthermore, an air of skepticism and distrust of the government exists among certain populations that have historically been discriminated against in health research. Receptivity to public health information and vaccination messages is likely to be negatively affected as a result. Special efforts may be needed to reach certain populations such as African-Americans and American Indians with HPV messages that are perceived to be trustworthy.
The second major finding dealt with attitudes toward HPV. The public health and medical community must disconnect HPV from notions of promiscuity and stigma. While significant media attention has focused on the sexual nature of HPV transmission, much of the information is incomplete and fails to emphasize the importance of the link between high- risk HPV types and cervical cancer.54 Whereas the preponderance of studies support
increasing knowledge about HPV, it should be noted that raising public awareness has been associated with increased anxiety and fear among some groups. In addition, previous
research findings suggest that raising awareness of the HPV-STD-cervical cancer link could potentially result in further stigmatization of HPV, cervical cancer, cervical cancer screening, and HPV vaccination.54, 58
Given the lack of a cure for HPV or agreement on effective prevention strategies for sexually active adults, and no approved test to detect HPV in men or no vaccine approved for boys, the public health community must be careful not to cause undue public alarm while promoting HPV awareness. Framing HPV as a cause of cervical cancer and universal public health issue as opposed to an STI will improve education efforts and the public’s attitude toward HPV. The sexually transmitted nature of HPV could have further implications for vaccine adoption and the establishment of supportive state vaccination policies in the U.S.
The third finding addresses acceptance of the HPV vaccine. Misperceptions about vaccine safety pose additional barriers to use and add to the fear of vaccination. There appear to be reservations related to the newness and efficacy of the vaccine and its potential side effects.70 Support from national medical organizations and professional associations will play an important role in facilitating vaccine implementation.
Reidesel et al 61 reported that provider practice characteristics, knowledge about HPV, and attitudes were independently associated with intention to recommend HPV vaccination. Physicians whose focus is on women’s health issues and those that work with patients at high risk for HPV-related disease may have a better understanding of HPV
infection recognizing the potential health benefits of an HPV vaccine and thus more likely to recommend immunization.61 In contrast, there are some providers who may not recommend the vaccine to women who are sexually active or may have been exposed to HPV.
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HPV vaccination.71, 72 Results of a survey of physicians conducted by Raley et al 64 suggest that gynecologists are widely accepting of the HPV vaccine as a result of recommendation by the American College of Obstetricians and Gynecologists.73
As the number of suggested vaccines rise along with escalating costs, financing for newly recommended vaccines is a potential barrier, particularly among young adults without private health insurance who may be left with the decision to pay out of pocket. Young women will be responsible for the full list price of the vaccine series ($375.00) and additional expenses related to the administration of the vaccine and personal costs will be incurred. While the HPV vaccine has been added to the Vaccine for Children’s (VFC) program, individual states will have to decide whether to make it available in public health departments or covered as a benefit through state Medicaid programs. It is likely that financial barriers may impede achievement of high vaccination coverage among those for whom the vaccine is recommended and most likely to benefit.
Although attitudes about HPV vaccination are broadly positive, parents have concerns about vaccinating young girls against STIs. Similarly, conservative Christian groups and pro-abstinence lobbies have spoken out against the vaccine.70 The HPV vaccine should be seen and marketed as a cervical cancer prevention approach rather than one that promotes sexual promiscuity. Based on the literature, acceptability of the vaccine and its use should increase as the vaccine becomes more familiar and efficacy is proven over time.
There is also a concern that accomplishing effective implementation of an HPV vaccination program will lead to a reduction in adherence to Pap test screening. It is possible that as a result of this “success,” the number of cervical cancer cases could potentially increase. Implications for public health policy should be directed at timely vaccination in conjunction with prescheduled screening times to detect and treat cervical lesions.51