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

Cervical cancer remains a major cause of morbidity and mortality among women in India, particularly among marginalized communities who face heightened vulnerability to Human papillomavirus (HPV)-related disease. As India prepares for the national rollout of HPV vaccination for girls aged 9-14 years, understanding community-level knowledge, attitudes, and acceptability is essential to ensuring equitable uptake. This study explored perceptions of HPV vaccination among marginalized populations across three diverse Indian settings.

A multi-site qualitative study was conducted between February and October 2023 in Delhi-NCR, Tripura, and Karnataka. Semi-structured interviews (n = 89) and gender-specific focus group discussions (n = 12) were undertaken with tribal women, migrants and internally displaced women, women living with HIV, female sex workers, and men from tribal and migrant communities. Data were analyzed thematically using Braun and Clarke's framework.

Awareness of HPV vaccination was extremely low, with only 14 participants having heard of the vaccine, and only one male participant aware of it. While many participants expressed willingness to vaccinate themselves or their daughters, others held cautious or negative views rooted in concerns about side effects, fertility, moral beliefs, and confusion linked to the COVID-19 vaccination experience. Gendered decision-making norms shaped vaccine acceptance, with many women relying on husbands or senior family members for consent. Participants emphasized culturally grounded, community-based strategies for vaccine introduction, including locally tailored communication and engagement through trusted community actors.

This multi-site qualitative study highlights the interplay of limited knowledge, gendered power dynamics, stigma, and trust in shaping HPV vaccine acceptability among marginalized populations in India. To enhance vaccine knowledge and acceptability, tailored community engagement, culturally responsive communication, and inclusive decision-making processes are essential. As India advances towards national HPV vaccine rollout, addressing these factors will be critical for achieving equitable coverage and supporting cervical cancer elimination goals.