HPV Vaccination and young people with intellectual disability and from ethnic minority backgrounds

Projet summary

Introduction

In the United Kingdom (UK), cervical cancer is the second most common cancer in women under 35 years. Human papillomavirus (HPV) types 16 and 18 are sexually transmitted viruses which may contribute towards over 70% of cervical cancer cases. Since 2008 a national school-based HPV vaccination programme has been implemented in Scotland. This programme has targeted schoolgirls aged 12-13 with high uptake rates above 90%. A three-year catch-up campaign has also been offered to vaccinate girls aged 13 to 17. However, studies have suggested that some sub-groups may be missed and are harder to engage in the HPV vaccine programme. Two such sub-groups include young people from an ethnic minority background and those diagnosed with an intellectual disability. Little research has specifically focused on these groups. This study focuses on exploring the views and experiences of young people (16-26 years) with the HPV vaccine by targeting these under-represented groups.

Background

Cervical cancer is one of the most common cancers in the world and the second most common cancer for women under 35. The HPV (Human Papillomavirus) Vaccine was recently introduced internationally in order to provide a vaccine for preadolescent females prior to sexual debut to protect against the sexually transmitted HPV virus. Strands HPV16 and HPV18 of the virus are responsible for over 70% of cases of cervical cancer and the HPV vaccine contains antigens from these two high-risk oncogenic types. A national government school-based vaccination programme is adopted in Scotland and the rest of the United Kingdom. Scotland has achieved high uptake rates for this vaccine since it was introduced in 2008 in the target population: school girls aged 12-13 years and a catch up campaign for three years which targeted older girls.

School nurses have contributed to the delivery of this vaccine, in the face of limited knowledge amongst adolescents’ about the vaccine and the relationship between the HPV virus and cancer. Cervical cancer prevention is also promoted through a national cervical screening programme. In some countries such as the United State and Australia, the vaccine has also been licensed for use amongst males as the vaccine is also effective in the prevention of genital warts and oral and anal cancers. Currently the vaccine is not offered to males in the UK. There is little research exploring males’ perceptions of the vaccine and of their role in the transmission of this sexually transmitted virus, outside of North America.

While vaccine uptake for the HPV vaccine remains high overall in Scotland, some recent UK studies have suggested that some sub-groups may be missed or harder to engage in this vaccine programme; although vaccine uptake rates for specific sub-groups are not available. One such group is young people from an ethnic minority background as we know that this group is less likely to access a range of healthcare services including cervical screening. Hence young women from ethnic minority background may be at greater risk of infection from sexually transmitted infections and cervical cancer rates.

In addition, we know that people from ethnic minority backgrounds may be disproportionally represented in social deprivation and hence both ethnicity and deprivation should be considered. High deprivation has been associated with higher incidence of high-risk HPV infection. It is important to have an understanding of the socio-cultural influences underpinning vaccine behaviour in recognition of the context in which this takes place.     

Another sub-group of relevance for the HPV vaccine is young people diagnosed with a learning or intellectual disability who may be particularly vulnerable. As far as the team are aware, there is no research specifically focusing on young people with an intellectual disability for the HPV vaccine. Vaccination is not a neutral public health intervention but may be controversial and persist even in contexts with high vaccination uptake rates such as Scotland.

Aims

This study proposes an in-depth exploration of the views and experiences of these two under-represented groups in a Scottish sample in order to provide rich understandings about vaccine access and perceptions of the barriers and facilitators towards vaccination in these sub-groups. This exploratory study is timely and will consider some of the social, psychological and cultural implications associated with the HPV vaccine amongst young people from these sub-groups across: gender, ethnicity and diversity including socio-cultural and psychological aspects of vaccination, and intellectual disability and inclusion.