HPV vaccination initiation and completion among sexual minority women in California.

Abstract

e22573 Background: Human papillomavirus (HPV) is the most common sexually transmitted infection and a known cause of cervical cancer globally. Despite this, vaccination coverage remains below national targets in the United States. Sexual minority women (SMW), those who identify as lesbian, bisexual, or other non-heterosexual orientations, face distinct barriers to accessing preventative healthcare. Patient and provider misconceptions about HPV risk, provider bias, and SMW intersecting identities influence how they navigate the healthcare system. California has the largest LGBTQ+ population in the United States, yet the absence of California-specific data on HPV vaccination represents a critical gap in public health. This database study aimed to examine HPV vaccination initiation and completion among SMW in California to identify and close gaps in the literature. We hypothesize that SMW would have lower HPV vaccination initiation and completion compared to their heterosexual counterparts. Methods: Using data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), we examined HPV vaccination rates among SMW in California. The analysis was done using R. Based on the 2016 codebook, survey respondents who were coded from California, answered female under "Respondents Sex," and answered either "straight," "lesbian or gay," "bisexual," or "other" sexual orientation/gender identity were included in the analysis. In this context, sexual minority women were defined as either lesbian or gay, bisexual, and/or other given the limitations of the survey. Respondents' ages are aggregated into 5-year blocks; therefore, the respondents analyzed were aged 18 to 49, to include those aged 45. Weighted percentages and 95% confidence intervals were estimated using BRFSS design variables to account for the complex sampling design. Results: 2289 females met the criteria filters above, of whom 2160 identified as straight and 129 as SMW. Of these, 1593 straight women and 95 SMW had missing data on their HPV vaccination status. Therefore, 567 straight women and 34 SMW were included in the vaccination analysis. We found that 26.9% (95% CI 22.0-31.8) of straight women in California initiated HPV vaccination, and 13.0% (95% CI 9.6-16.5) completed HPV vaccination. Compared to straight women, SMW had a lower HPV initiation rate of 21.5% (95% CI 6.0-37.0) and an even lower HPV completion rate of 10.5% (95% CI 0.0-22.1). Conclusions: To our knowledge, this is the first study attempting to characterize and aggregate HPV vaccination data for SMW in California. Similar to national trends, SMW in California had lower HPV initiation and completion rates compared to their heterosexual counterparts. Further, more focused survey questions and research are needed to better inform targeted public health interventions to improve vaccination rates in California, especially among SMW of color.