Research Article: Acceptability of HPV vaccines and associations with perceptions related to HPV and HPV vaccines among male baccalaureate students in Hong Kong

Date Published: June 18, 2018

Publisher: Public Library of Science

Author(s): Teris Cheung, Joseph T. F. Lau, Johnson Z. Wang, P. K. H. Mo, Y. S. Ho, Ray Borrow.


The highly infectious human papillomavirus (HPV) causes both genital warts and cervical cancer in women. In 2009, the prevalence of genital warts in Hong Kong was 203.7 per 100,000 person-years. Cervical cancer, more seriously, was the eight most common cancer among women and girls in Hong Kong, accounting for 2.3% of all new cancer cases in females in 2014. Cervical cancer is a significant global public health problem and HPV is a major risk factor leading to the development of cervical cancer. HPV is also the most common sexually transmitted disease among university students. This is the first study to examine the acceptability of HPV vaccines and associations with perceptions related to HPV and HPV vaccines among the male baccalaureate student population locally.

A self-administrative cross-sectional survey was used to assess whether male baccalaureate students from eight local Hong Kong universities intended to be immunized for HPV. The study also asked questions concerning how its subjects perceived HPV and HPV vaccines using the Health Belief Model. Data collection spanned from June to September 2015. A multiple stepwise regression model was used to examine associations between cognitive factors and subjects’ intention to take up the HPV vaccine.

A total of 1,004 (83.7%) students aged 18 and 26 participated in this study. 23.3% found vaccinating for HPV acceptable, a level correlating with a number of indicators. Subjects were more likely to find vaccinating acceptable if 1) they knew something about HPV vaccines; 2) they understood that men were susceptible to infection by HPV; 3) they realised they could benefit by HPV vaccination, and 4) they were aware of the arguments for and against HPV vaccination, as disseminated by either the media or peers.

HPV remains a significant public health concern in Hong Kong and China more broadly. This study’s findings show a disconnect between the perceived and actual risk of being infected with the HPV vaccine among male baccalaureate students. This disconnect may be bridged by informing young men of the benefits of their being vaccinated against HPV, by removing the psychological and financial barriers that prevent them from taking up the vaccine and by improving how primary healthcare providers motivate them to get immunized.

Partial Text

Human papillomavirus (HPV) infections are the world’s most common sexually transmitted infections (STI) among men and women in the world [1]. Human papillomavirus (HPV), a highly transmissible virus, is acquired from infected persons mainly through sexual, particularly vaginal and anal, intercourse [2]. A recent systematic review (2001 and 2012; of 37 studies: 15 from Europe; 10 from North America; 1 from Canada; 5 from Asia; 3 from South America; 2 from Australia and 1 multiregional) of the prevalence of genital warts reported an overall (male and female combined) annual incidence of anogenital warts (AGWS) ranging from 160 to 289 per 100,000 [3]. In the United States, approximately 3 to 4 million cases of genital warts occurred in men each year, at a peak rate of 500 per 100,000 in age between 25 and 29 [4]. In 2009, the incidence of genital warts for males in Hong Kong was estimated to be 292.2 per 100,000 persons per year [5]. Men more prevalently report AGWs than women [3, 5]. According to these prevalence estimates, Hong Kong ranks third among all countries in the systematic review conducted by [3] and is the most at-risk city for genital warts. Men are also at risk for other HPV- related cancers including penile, anal and oral cancers [6]. Penile cancers contributed to a very small fraction (0.4% to 0.6%) of all male cancers in the United States and Europe. Nevertheless, the incidence of penile cancers is almost 20-fold among Asia men [6]. Penal and oral cancers are also known to be more prevalent among men who are having sex with men (MSM) [7] than among general male population [8]. Sexual behaviours including multiple sex partnership and male-homosexual oral sex are associated with increased risks of HPV-associated cancers. Recent evidence has estimated that 60% to 70% of oropharyngeal squamous cell cancer (OPSCCs) was associated with HPV infection in the United States [9]. The Centers for Disease Control and Prevention also estimated that over 15,000 HPV-associated OPSCCs were diagnosed annually in the United States and the oropharynx (head and neck) cancer have increased in incidence [10]. The number of lifetime sexual partners in heterosexual men is also a strong risk factor of HPV[11], regardless of their age[12].

The Centre for Health Protection at the Department of Health in Hong Kong promotes HPV vaccination over an electronic platform. It has secured extensive coverage in the media and has passed to private clinics all the information that is necessary to get vaccinated. Unexpectedly, one third of the study participants (33.8%) had never heard of HPV. About half (50.6%) asserted that HPV was recently discovered.

HPV is a significant public health concern for university-aged men. This highly infectious disease can lead to serious health outcomes. This study has uncovered the prevalence of male university students’ willingness to be vaccinated against HPV in Hong Kong, unveiling significant composite factors associated with the perceived acceptability of HPV vaccines. The study cohort seriously underestimate the chance they will get HPV as evidenced by our findings emerging that less than one quarter of our participants had the intention to take up HPV vaccine. Such a disconnect follows from a knowledge deficit. Participants’ sense of their susceptibility mean that the disadvantages (or inconvenience) of taking the course of prophylactics outweigh any benefits they see themselves incurring. Too many barriers stand in the way of their getting immunized; and there are too few cues to action motivating them to self-efficacious preventative behavior. Healthcare providers should focus on removing these psychological and financial barriers before progressing to the next stage of any health promotion campaign. Health policy-makers should consider a sponsored trial of a free HPV vaccination programme of an at-risk population to examine the cost-effectiveness of this preventative measure.




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