Background: Since the introduction of HPV vaccination, research has focused on the potential elevation of sexual risk behaviour among vaccinated individuals, while the sexual risk behaviors and accrued risk of morbidity and mortality of infection in the unvaccinated population has been largely ignored (1-3). This research focuses on the sexual risk behaviors of young adult Canadians who have not been vaccinated against HPV despite a publicly funded national vaccination program for females and authoritative recommendation of vaccination for males.
Methods: 646 Canadian university undergraduates completed a self-administered survey assessing sexual risk behavior and HPV vaccination status. Sexual risk behaviors were analyzed as a function of gender and HPV vaccination status.
Results: 537 (154 men and 383 women aged 17-23) of 646 participants who met eligibility requirements were analyzed. 48.30% (n = 185) of female and 89.61% (n = 138) of male participants had not been vaccinated. 51.35% (n = 95) of unvaccinated women were coitally experienced with a median of 2 partners (range 1 – 100 partners); 55.07% (n = 76) of unvaccinated men were coitally experienced with a median of 2 partners (range 1 – 40 partners). 49.19% (n = 91) of unvaccinated women reported receptive oral sex experience with a median of 2 partners (range 1 – 23 partners); 22.46% (n = 31) of unvaccinated men reported receptive oral sex experience with a median of 2 partners (range 1 – 20 partners). 6.49% (n = 12) of unvaccinated women reported anal sex experience with a median of 2 partners (range 1 – 10 partners); 2.90% (n = 4) of unvaccinated men reported anal sex experience, with a median of 1 partner (range 1 – 15 partners). HPV vaccination status was not associated with difference in number of vaginal or anal sex partners, age of sexual debut, or consistency of condom use (all P >0.05). Unvaccinated status was associated with the belief that HPV vaccine is not safe (P<0.001), is less effective than claimed (P=0.001), and is promoted by drug companies to make a profit (P=0.002).
Conclusion: Despite availability of a publicly funded vaccination program for women and recommendation of vaccination for men in Canada, a substantial proportion of Canadian young adults sampled remained unvaccinated. Critically, unvaccinated men and women commonly engaged in sexual risk behaviors for HPV infection and generally engaged in sexual risk behaviors at the same level as their vaccinated counterparts. Findings contribute to an evidence-based case for redoubling efforts to encourage HPV vaccination among young unvaccinated individuals who are commonly at risk of HPV infection.
1. Fisher, W.A., (2012). Understanding human papillomavirus vaccine uptake. Vaccine, 30S: F149–F156.
2. Fisher, W. A., Kohut, T., Salisbury, C., & Salvadori, M. (2013). Understanding human papillomavirus vaccination intentions: Comparative utility of the Theory of Reasoned Action and the Theory of Planned Behavior in vaccine target age men and women. Journal of Sexual Medicine. 10:2455–2464.
3. Zimet, G.D., Rosberger, Z., Fisher, W.A., Perez, S., & Stupiansky, N.W. (2013). Beliefs, behaviors and HPV vaccine: Correcting the myths and the misinformation. Preventive Medicine, 57: 414-418.