Knowledge and Awareness of Human Papillomavirus (HPV) and HPV Vaccines among Caribbean Youth: The Case of the Bahamas

"For health officials, it is important to measure HPV and HPV vaccine knowledge as part of HPV prevention program planning."

Conducted in the Bahamas, this study of young people's understanding of human papillomavirus (HPV) and HPV vaccine was conducted in 2014-15, prior to the introduction of the vaccine into the national schedule of the immunisation programme. At that time, Cervarix and Gardasil had become available in private physicians' offices for a fee, and there were widespread discussions in the media about the future government-funded programme. For countries that have not yet implemented their HPV vaccine strategy, this study offers lessons on the importance of assessing HPV and HPV vaccine knowledge prior to programme implementation.

The established rapport between the Ministry of Health (MOH), the Bahamas National AIDS Program (NAP), and the Ministry of Education (MOE) was used to facilitate student recruitment through The Focus on Youth Program. This programme involves working with parents and their children to improve sexual health communication. In total, 1,553 students aged 15-17, 51.4% of whom were males, completed printed questionnaires.

Only 10.7% (146/1,364 who answered that question) had ever heard of HPV. With respect to those who were sexually active (n = 685), only 10.7% had ever heard of HPV. (The researchers call these results unexpected, considering that there was much discussion in the media about the merits of HPV vaccines at the time.) Young men's awareness of HPV was lower than that of young women, perhaps because, in 2013, most of the debate on HPV had focused on a female-only HPV vaccine programme. For some time, the discussion of a male HPV vaccine strategy focused only on men who have sex with men, a topic that would not be given much media attention in Caribbean societies.

Going beyond awareness, none of the youth in the study who had heard of HPV were able to correctly answer all the knowledge questions. This indicates that general information about HPV had not penetrated this youth group, despite media discussions in the United States (US). Also, the data demonstrate that the misunderstanding that "men cannot get HPV" was prevalent, which suggests that it is "imperative that the health promotion programs and the media include men in the rhetoric of HPV prevention."

Youth had poor knowledge of the HPV vaccine, including being unaware of its association with cervical cancer prevention, dosing, and timing. Studies cited here have reported that poor understanding of the HPV vaccine can lead to resistance to vaccine uptake or poor adherence to vaccine dosage. In contrast, research has found that motivated youth may have an influence on their parents' consenting to the HPV vaccine.

In the Bahamas, the HPV vaccine programme was implemented after this study was conducted. Initial uptake of the HPV vaccine was poor, as reported here. This "emphasizes the need for countries in the region who have not yet implemented a program, to create well-designed, multifaceted, intensive educational strategies to maximize HPV vaccine uptake. This education must target youth, educators, health-care providers and parents."