Breaking barriers: Evaluation of a low-threshold community-based HPV vaccination model for gender minorities and sex workers in Milan.

Abstract

1542 Background: Human Papillomavirus (HPV) is the primary etiological factor for anogenital and oropharyngeal cancers. Sexual and gender minorities (SGM) and sex workers (SW) face an increased risk of HPV-related diseases but encounter significant barriers to vaccination, including stigma, discrimination in healthcare settings, and low risk perception. "VaccinaMILAN*" is a community-based initiative designed to enhance vaccine accessibility by offering the first dose of the 9-valent vaccine in safe and inclusive environments, such as Milan's "rainbow" districts during weekend evening hours. This study assessed the demographic characteristics, risk factors, and barriers within this hard-to-reach population. Methods: An anonymous paper-based questionnaire was administered to participants vaccinated during the May and October 2024 editions of VaccinaMILAN*. The survey evaluated demographics, gender identity, sexual behaviors, HPV knowledge, vaccination barriers, and satisfaction with the community approach. Categorical variables were described using frequencies and percentages; data were analyzed using Chi-square tests (two-tailed p-value < 0.05). Results: 320 questionnaires were collected (response rate: 76.2%). Most respondents were under 35 years old (68.7%) and held a university degree (65.9%). The sample primarily consisted of cisgender MSM (76.9%), followed by cisgender female SWs (13.4%) and gender minorities (9.8%). Despite a high prevalence of receptive anal intercourse (61.7%), 95.4% had never undergone anal cancer screening. HPV knowledge was significantly higher among younger participants (p = 0.0063) and university graduates (p = 0.0169). Reported barriers included: 45.7% did not know how to access vaccination; 25.4% did not perceive themselves at risk; approximately 20% had previously experienced vaccination refusal in traditional healthcare settings. Overall, 99.7% expressed satisfaction with the initiative. Conclusions: The VaccinaMILAN* project demonstrates the effectiveness of a multidisciplinary community-based approach in improving vaccine equity for marginalized populations. The findings highlight the urgent need for targeted awareness campaigns and specific training for healthcare providers regarding HPV vaccination and anal cancer screening recommendations for these populations.