Clinicians' self-reported HPV vaccination recommendations for sexual and gender minority patients

There are multiple human papillomavirus (HPV)-related disparities experienced by sexual and gender minority (SGM) populations in the United States (U.S.), including higher rates of some HPV-associated cancers, lower rates of HPV vaccination among certain subgroups, and higher rates of healthcare discrimination.

We conducted a national cross-sectional survey of U.S. primary care clinicians (physicians and advanced practice providers [APPs]) in 2024 to examine HPV vaccination recommendation practices for SGM patients. Participants responded to a series of six clinical vignettes which varied by patients' sexual orientation, sex assigned at birth, and gender identity.

The sample (n = 483) was primarily non-Hispanic (93%), White (74%), physicians (56%), and did not practice in a rural/frontier community (70%). Across the vignettes, regardless of patient characteristics, 59-69% reported they would always recommend the HPV vaccine; whereas 9-19% reported they would recommend the HPV vaccine often (50-79% of the time). The vast majority were highly consistent in recommendation likelihood across vignettes. Greater likelihood of recommending the HPV vaccine was observed for APPs versus physicians (p = 0.016), female clinicians versus males (p < 0.001), and non-Hispanic White clinicians versus other racial/ethnic groups (p = 0.006).

In summary, participants generally reported high likelihood of recommending the HPV vaccine, with recommendations differing very little by patient sex, sexual orientation, or gender identity.