STIGMA, ATTITUDES, AND WILLINGNESS TOWARD THE HPV VACCINE AMONG YOUNG ADULTS IN PAKISTAN: A MIXED-METHODS STUDY

Background: Cervical cancer is a major health concern worldwide and the major cause of it is human papillomavirus (HPV) infection, however, and the vaccination rates in Pakistan are very low. Social stigma, negative attitudes, and cultural beliefs are the main factors responsible for the vaccine hesitancy among the young adult population in Pakistan. Objective: This research aimed to assess the stigma, attitudes, and willingness towards HPV vaccination among young adults in Pakistan, analyze the differences between genders, and find out the individual, sociocultural, and systemic factors contributing to vaccine hesitancy. Methods: The research was carried out with a cross-sectional mixed-methods approach and involved 286 participants aged between 18 and 29 years. The quantitative measures focused on the stigma, attitudes, and willingness to receive the vaccine, while open-ended survey questions provided qualitative information. The data obtained was subjected to analysis including descriptive statistics, correlations, chi-square tests, and thematic analysis. Results: The taboo was reported to be moderate to high by the participants (39.2%), very few of them had moderate to high positive attitudes (37.8% low, 31.8% high), and the majority were not willing to get vaccinated (64.7% unwilling). Attitudes had a direct relationship with the willingness of the participants (r = .64), whereas stigma had an inverse relationship with the attitudes (r = -.39) and the willingness (r = -.62). Women than men displayed more willingness and had more positive attitudes, while the level of stigma was found to be the same in both genders. The qualitative findings pointed to barriers such as ignorance, fear of adverse effects, family and male-dominated society influence, misinformation in the community, and lack of trust in the health system. Conclusions: The HPV vaccine hesitancy of young adults in Pakistan is largely determined by stigma and attitudes along with socio-cultural and systemic factors. To remedy the situation, it is necessary to have an implementation of evidence-based, culturally appropriate interventions along with policy measures that will facilitate access to the vaccine and thus prevent HPV-related cancers by increasing vaccination coverage.