Marginalized voices on HPV vaccination in India: exploring knowledge, attitudes, and acceptance

Area of Science:

• Public Health
• Vaccinology
• Sociology

Background:

• Cervical cancer is a significant health burden in India, disproportionately affecting marginalized women vulnerable to Human Papillomavirus (HPV).
• India's upcoming national HPV vaccination program for girls (9-14 years) necessitates understanding community perceptions for equitable access.
• This study investigates HPV vaccination perceptions within diverse marginalized populations across India.

Purpose of the Study:

• To explore knowledge, attitudes, and acceptability of HPV vaccination among marginalized communities in India.
• To identify barriers and facilitators to HPV vaccine uptake in preparation for national rollout.
• To inform culturally sensitive strategies for promoting HPV vaccination in diverse Indian settings.

Main Methods:

• A multi-site qualitative study conducted from February to October 2023 in Delhi-NCR, Tripura, and Karnataka.
• Involved semi-structured interviews (n=89) and focus group discussions (n=12) with various marginalized groups, including tribal women, migrants, women living with HIV, and female sex workers.
• Thematic analysis using Braun and Clarke's framework was applied to the collected data.

Main Results:

• Very low awareness of the HPV vaccine was observed, with only 14 participants having prior knowledge.
• Willingness to vaccinate coexisted with concerns regarding side effects, fertility, moral beliefs, and mistrust stemming from COVID-19 vaccine experiences.
• Gendered decision-making dynamics were prominent, with many women deferring to male family members for consent.

Conclusions:

• Limited knowledge, gendered power structures, stigma, and trust issues significantly impact HPV vaccine acceptability in marginalized Indian populations.
• Culturally tailored communication, community-based engagement, and inclusive decision-making are vital for improving vaccine knowledge and acceptance.
• Addressing these factors is critical for achieving equitable HPV vaccine coverage and advancing cervical cancer elimination goals in India.