Ejaz Muslima, Ekström Anna Mia, Ahmed Alyan, Haroon Aymen, Ali Dania, Ali Tazeen Saeed, Salazar Mariano
Department of Global Public Health Karolinska Institutet, Stockholm, Sweden.
Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
BMC Public Health. 2022 Feb 22;22(1):378. doi: 10.1186/s12889-022-12775-z.
Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.
A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.
Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis.
Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding.
The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
男男性行为者（MSM）和跨性别者因性传播的人乳头瘤病毒感染而面临更高的尖锐湿疣和肛门癌风险。本研究探讨了巴基斯坦男男性行为者和跨性别女性对人乳头瘤病毒（HPV）感染及HPV预防策略（筛查和疫苗接种）的看法。
2019年3月至8月在巴基斯坦卡拉奇进行了一项定性研究，采用焦点小组讨论（FGD）的方式，参与者为自我认定的男男性行为者、男性性工作者和跨性别女性。
参与者从为男男性行为者和跨性别女性服务的社区组织（CBO）中招募。共有38名男性和10名跨性别女性参加了6次焦点小组讨论。讨论内容被记录、翻译、逐字转录，并采用内容分析法进行分析。
从分析中确定了三个主题。分别是：1）对性传播感染和HPV的知识及风险认知；2）对HPV预防的信念和态度；3）参与者对HPV疫苗接种和肛门巴氏筛查的建议。参与者表示对HPV及其健康后果缺乏了解，因为政府和当地社区组织只关注HIV。没有参与者听说过HPV预防措施，包括男性的疫苗接种和肛门巴氏筛查，但他们对预防措施持积极态度。尖锐湿疣和肛门癌被视为已知风险行为的严重潜在后果。所有参与者表示他们有兴趣接种HPV疫苗，但承认性传播感染（STI）服务的提供不足以满足关键人群的需求，且未被政府列为优先事项。HPV预防的主要认知障碍包括成本以及获得公共医疗服务或与医疗服务提供者公开讨论性取向方面的挑战。参与者普遍更喜欢社区组织，因为其工作人员态度更专业、公正，尊重患者的尊严、保密性和隐私。大多数参与者认为，如果政府不合作，社区组织应该为消除HPV而努力，并通过国际资金筹集资金。
本研究结果可帮助公共卫生政策制定者和研究人员了解这一少数群体对HPV预防的看法。鉴于对HPV感染及其负面健康后果的了解程度较低，需要通过HPV宣传册将HPV教育与性传播感染教育及意识相结合，以有效教育目标人群。
