Knowledge, Attitude, and Barriers Towards Human Papillomavirus (HPV) Vaccination Among Youths of Karachi, Pakistan

"There is a stigma associated with HPV due to its association with cervical cancer, leading to a lack of open dialogue surrounding reproductive health in low and middle-income countries, making it difficult and sometimes nearly impossible to overcome preventable issues concerning sexual health..."

The potential of a vaccine to reduce disease burden relies on its acceptance and uptake by the community, which in turn rests on effective community health education and awareness-raising. A lower-middle-income country with a high burden of cervical cancer, Pakistan nonetheless lacks an effective nationwide human papillomavirus (HPV) screening and vaccination programme. As a result, the Pakistani population may be unaware of there being such a vaccine, and uptake remains low. This study was conducted with the hope that information about knowledge, attitudes, and barriers related to HPV vaccination could not only help healthcare planners formulate a plan for the prevention of HPV infections in Pakistan but also narrow the knowledge gap related to HPV vaccination between developed and developing countries.

A cross-sectional study was conducted in Karachi, Pakistan, between April and May 2019. Following a literature review, a standardised questionnaire was designed and distributed among 400 participants aged 18-26, of whom 70% were female. Selected findings:

• A majority of the participants (n=223, 79.6%) cited the study itself as their source of knowledge about HPV. (Other sources were: social media (n=85, 30.3%), friends (n=45, 16.0%), doctor (n=30, 10.7%), and family (n=33, 11.8%).)
• Of the 18 people who were vaccinated, 8 belonged to the high-income category category, and nearly two-thirds (n=11, 61.1%) had gotten vaccinated upon the recommendation of their doctor.
• The majority of participants considered the HPV vaccine to be safe, effective, and necessary. However, a quarter of the study population (n=101) believed that HPV vaccination promoted sexual activity in young adults, and nearly half perceived the vaccine to be time-consuming (n=167, 41.8%) and overpriced (n=187, 46.8%).
• Of the participants who were not vaccinated for HPV (n=382, 95.5%), the intention for a future HPV vaccine was seen in 62.0% of subjects (n=237). The resolve for a future HPV vaccination was higher in females (n=185, 78.1%). Within the population unvaccinated for HPV, 95.5% (n=365) claimed they would consider getting vaccinated for HPV in the future if their doctors recommended it.

In light of the low HPV vaccination rate in Karachi, Pakistan, and the findings of this study, the researchers suggest that concentrated efforts involving the healthcare system should be made to raise awareness regarding HPV and its vaccine, thereby reducing barriers to HPV prevention. Specifically, the results:

• signify the crucial role healthcare professionals play in raising awareness and promoting the acceptability of the HPV vaccine and the need for more effective and widespread communication between the physicians and the general population;
• imply the need for the government to offer free or subsidised vaccinations that are readily available to the general population - specifically, young adolescents aged 9-14;
• highlight the role of schooling in raising awareness regarding HPV, which is supported by studies showing that better education regarding HPV leads to an increased willingness to get vaccinated;
• suggest the importance of widespread, culturally sensitive educational campaigns involving family, especially parents (who often hold decision-making power), to remove the preconceived notion and fear that the use of the HPV vaccine can lead to sexual promiscuity;
• indicate the need to direct prevention and educational programmes toward males, as well, as they tend to be unaware of the fact that HPV can cause numerous diseases in men too; and
• unearth the promise of mediums such as television and social media to raise awareness regarding the safety and effectiveness of the HPV vaccine, thereby encouraging positive attitudes towards it.

The researchers indicate that a similar study conducted on a larger scale encompassing multiple rural and urban areas of the country would provide a nationwide result on the knowledge, acceptability, and uptake of the HPV vaccine. A countrywide immunisation campaign reaching both men and women can then be initiated by the government, involving physicians who can dispel false information associated with the HPV vaccine.