Acceptance and Willingness to Receive HPV Vaccination Among Adult Women Living With HIV and Their Children
Nzube Ekpunobi, Ngozi Idemili-Aronu, John Olawepo, Echezona Ezeanolue, Gregory AaronsPURPOSE
Human Papillomavirus (HPV) vaccination is a primary preventive strategy for cervical cancer, yet its implementation remains challenging in sub-Saharan Africa. Women living with HIV (WLHIV) are a high-priority group due to their increased risk of persistent HPV infection. This study evaluates the current levels of HPV vaccine awareness and the willingness of WLHIV to accept the vaccine for themselves and their female children in Nigeria.
METHODS
This multi-center cross-sectional study analyzed data from 4,613 WLHIV across 12 clinical sites. Participants were surveyed on vaccine awareness, personal vaccination history, and future willingness to vaccinate themselves and their children. Logistic regression analysis and Chi-square tests were utilized to determine the relationship between awareness and willingness, applying the Haldane-Anscombe correction for zero-frequency cells where appropriate.
RESULTS
Awareness was critically low; only 10.4% (n = 481) of participants had ever heard of the HPV vaccine. This deficit in literacy directly influenced behavioral outcomes: only 8.2% (n = 378) were willing to receive the vaccine personally, 0.6% (n = 26) declined, and 0.6% (n = 26) were uncertain. Willingness to vaccinate female children was even lower, with only 1.1% (n = 50) indicating acceptance, while the vast majority had no recorded response. A crucial finding was the absolute correlation between knowledge and intent, as zero (0%) women who were unaware of the vaccine expressed willingness to receive it. In contrast, awareness was a near-perfect predictor of acceptance (
CONCLUSION
The findings reveal a profound deficit in vaccine literacy among Nigerian WLHIV. The near-total absence of willingness in the absence of awareness confirms that literacy is the fundamental gateway to uptake. Public health strategies must prioritize intensive, provider-led educational interventions and normalize HPV vaccination within routine HIV care to overcome current levels of hesitancy and improve multi-generational cancer prevention.