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HPV Vaccination in Diverse Communities
Breaking Barriers: Enhancing HPV Vaccination Across Diverse Communities

Released: October 30, 2024

Expiration: October 29, 2025

Tracy Zivin-Tutela
Tracy Zivin-Tutela, MD
Activity Information

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Key Takeaways
  • LGBTQ Populations: Many women in same-sex relationships do not perceive themselves as being at risk for human papillomavirus (HPV).
  • Adolescents: Adolescents often believe HPV vaccine implies sexual activity; focusing on HPV as cancer prevention can help shift perception.
  • Rural Populations: Limited healthcare access and provider hesitancy emphasize the need for more provider and patient education to increase uptake.

It can be frustrating, disappointing, and heartbreaking when care has to shift from prevention to treatment of a vaccine-preventable disease. That’s why I try to be proactive in recommending vaccinations. Here are approaches I take for human papillomavirus (HPV) vaccination in key populations.

LGBTQ Population
My discussions about HPV vaccination with the LGBTQ population reveal significant awareness gaps, particularly among women. Many patients are unaware of their own risk factors or the recommendation for vaccination. For instance, women in same-sex relationships often do not perceive themselves as being at risk for HPV, leading to lower vaccination consideration and vaccination rates. So in my practice, whether in an office or hospital setting, I prioritize comprehensive preventative care by using this opportunity to discuss HPV, COVID-19, or pneumococcal vaccines.

Misconceptions About HPV Risk
A common misconception among patients is that having fewer sexual partners equates to a lower HPV risk. Some patients, regardless of their number of partners, mistakenly categorize the HPV vaccine as solely intended for adolescents or teens, unaware that vaccination is beneficial up to age 26, and even up to age 45 in certain cases under shared decision-making guidelines.

In addition, many patients are unclear about where to get vaccination—whether through a doctor, pharmacy—or whether a prescription or counseling is required. This uncertainty can create barriers to vaccination uptake. Addressing these gaps through education and targeted interventions is important. In all healthcare settings, including urgent care, primary care, and sexually transmitted disease clinics, healthcare professionals (HCPs) should use every patient interaction to provide education and recommend the HPV vaccine.

Another prevalent issue I encounter is that patients with a prior HPV diagnosis often think vaccination provides no further benefit, reasoning, “I already have HPV; why should I get vaccinated?”

I explain to these patients that the HPV vaccine covers multiple different serotypes, so even those previously diagnosed can gain protection against strains they haven’t encountered. Although it won’t impact an existing infection, it still provides valuable prevention.

Adolescents
Patients in their 20s often lack consistent, routine healthcare, seeking care sporadically for acute issues in urgent care or quick clinics. This lack of regular engagement with HCPs limits opportunities for discussing preventative measures like HPV vaccination. When these patients do seek care, it’s crucial to use these moments to educate and offer targeted interventions, ideally integrating HPV vaccination as a standard recommendation.

Adolescents often assume the HPV vaccine is not needed if they are not sexually active, or they may fear that accepting the vaccine may imply sexual activity to their parents. For these patients, I emphasize that HPV vaccination is best administered before exposure and is more important for cancer prevention. This is an important conversation to have, especially in states where parental consent is required, as teens may feel judged or misunderstood when parents are involved.

In addition, since the HPV vaccine is not mandatory for schools, it is often seen as less important, especially when there is a cost involved. Educating patients about HPV as a cancer-preventative measure can help shift this perception and encourage uptake.

Challenges in Rural Healthcare Settings
Rural communities face unique challenges, particularly in terms of transportation and limited healthcare access. HCPs in these areas may feel less comfortable promoting vaccines, including HPV, often due to politics and misinformation. That’s why we need to do a better job of educating our HCPs and patients, particularly in rural Southern states.

Although healthcare costs impact everyone, they affect rural populations more significantly. Public and private insurance, as well as federal and state programs like the Affordable Care Act (ACA), cover the HPV vaccine under preventative care guidelines and Advisory Committee on Immunization Practices (ACIP) recommendations. Public initiatives like Vaccines for Children (VFC) and the Public Health Service Act help, but gaps remain, especially for uninsured adults.

CHIP and Medicaid also cover all ACIP-recommended vaccines up to age 21. There are also public health service grants available to help physicians cover vaccine costs. Yet many families are unaware of these resources, highlighting the need for provider knowledge to guide patients to available services.

In summary, education and timely intervention are key. Ensuring that even a single dose is administered can make a significant impact.

Your Thoughts?
In your clinical practice, how often do you discuss HPV vaccination with your patients during routine healthcare visits?