In the Netherlands only girls are offered vaccination against human papillomavirus (HPV); free of charge. Men can become infected with HPV as well, and can develop HPV-induced diseases like genital and oral warts, penile, oropharyngeal and anal cancer. We studied the effect of out-of-pocket payment on the intention to get vaccinated against HPV among male clients of the sexually transmitted infections (STI) clinic in Amsterdam, the Netherlands.
Men aged ≥18 years were recruited from the STI clinic and asked to complete a web-based survey addressing HPV vaccination intention, measured on a 7-point Likert scale (-3 to 3); knowledge about HPV; socio-psychological determinants of HPV vaccination intention; demographics; and sexual behavior. The selected socio-psychological factors were derived from the Theory of Planned Behaviour and Social Cognitive Theory. Different amounts of out-of-pocket payment (€50;€100;€200;€350) were proposed to different groups of participants, based on the period of participation (the study duration was divided in 4 periods of roughly equal length). Univariable and multivariable linear regressions were performed to assess the impact of out-of-pocket payment on HPV vaccination intention.
Between June and October 2015, 1490 men participated; 1053 (71%) were men who have sex with men (MSM). HPV vaccination intention was very high (mean: 2.2, SD 1.2) if vaccination was free of charge. However, with each step increase in the required out-of-pocket payment for HPV vaccination, mean HPV vaccination intention decreased 0.74 (95%CI: 0.71 - 0.77) scale-point, to a mean value of -0.75 (SD 1.8) when out-of-pocket payment was €350. Also in multivariable analysis, including socio-psychological factors (attitude, self-efficacy, beliefs, social influences, and anticipated regret), and socio-demographics (age, sex group, and lifetime number of sex partner) HPV vaccination intention decreased by 0.74 (95% CI: 0.71 - 0.78) on the 7-point Likert scale, for each increment of price. Higher age was independently associated with higher intention to vaccinate, regardless of out-of-pocket payment.
HPV vaccination intention among male clients of the Amsterdam STI clinic is very high if free of charge. Out-of-pocket payment has a strong negative impact on HPV vaccination intention. These data suggest that if HPV vaccination for men would be offered at STI clinics, uptake would decrease substantially if out-of-payment would be required.