Main Article Content
human papillomavirus; HPV; gender; men's health; vaccination; health policy; public health
The human papillomavirus (HPV) can cause a range of cancers as well as genital warts and recurrent respiratory papillomatosis in men and women. Most cases can be prevented by vaccination in adolescence. Many countries vaccinate girls and an increasing number, although still a minority, vaccinate both boys and girls. The case for vaccinating boys is based on arguments of public health, equity, ethics and cost-effectiveness. The selective vaccination of females does not protect males sufficiently and provides no protection at all for men who have sex with men. In the United Kingdom (UK), the government’s vaccination advisory committee (Joint Committee on Vaccination and Immunisation [JCVI]) began to consider whether boys should be vaccinated as well as girls in 2013 and made clear in draft statements that it considered this not to be cost-effective. A campaign group, HPV Action, was established to advocate gender-neutral vaccination. This group became a coalition of over 50 organisations and used evidence-based arguments, political advocacy and media campaigning to make its case. One of its members initiated legal action against the government on the grounds of sex discrimination. In July 2018, the government agreed that boys in the UK should be vaccinated. The lessons for other campaigns in the men’s and public health fields include: be prepared for the long haul, focus on clear and specific goals, build alliances, align the objectives with existing policies, make a financial case for a change of policy, and use all legitimate means to exert pressure.
2. Viarisio D, Gissmann L, Tommasino M. Human papillomaviruses and carcinogenesis: well-established and novel models, Current Opin-ion in Virology 2017;26:56-62. doi.org/10.1016/j.coviro.2017.07.014.
3. CDC. Genital HPV Infection - Fact Sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm (accessed 18 February 2019).
4. CDC. HPV and Oropharyngeal Cancer. https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm (accessed February 2019).
5. American Cancer Society. HPV and Cancer, https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-cancer-info.html (accessed 21 February 2019).
6. Chesson H, Dunne E, Hariri S, et al. The Estimated Lifetime Probability of Acquiring Human Papillomavirus in the United States. Sexually Transmitted Diseases 2014;41(11):660–664. DOI: 10.1097/OLQ.0000000000000193
7. National Centre for Immunisation Research and Surveillance (2018). Human papillomavirus (HPV) vaccines for Australians: NCIRS Fact Sheet. http://www.ncirs.org.au/sites/default/files/2018-12/HPV%20Factsheet_2018%20Aug%20Update_final%20for%20web.pdf (accessed 21 February 2019).
8. Nyitray AG, Lin H-Y, Fulp WJ et al. Monogamy and Duration of Heterosexual Relationships in Human Papillomavirus Transmis-sion. The Journal of Infectious Diseases 2014;209(7):1007-1015. DOI: 10.1093/infdis/jit615
9. Smith JS, Gilbert PA.,Melendy A et al. Age-Specific Prevalence of Human Papillomavirus Infection in Males: A Global Review. Journal of Adolescent Health 2011;48(6):540-552.
10. Anic GM, Giuliano AR. Genital HPV infection and related lesions in men. Preventive Medicine. 2011;53(Suppl 1):S36-41. DOI: 10.1016/j.ypmed.2011.08.002
11. Konopnicki D, De Wit S, Clumeck N. HPV and HIV coinfection: a complex interaction resulting in epidemiological, clinical and therapeutic implications. Future Virology 2013;8(9):903-915. DOI: 10.2217/fvl.13.69
12. de Martel C, Ferlay J, Franceschi S et al. Global burden of cancers attributable to infections in 2008: A review and synthetic analysis. Lancet Oncology 2012;13(6):607-615. DOI: 10.1016/S1470-2045(12)70137-7
13. Hartwig S, St Guily JL, Dominiak-Felden G et al. Estimation of the overall burden of cancers, precancerous lesions, and genital warts at-tributable to 9-valent HPV vaccine types in women and men in Eu-rope. Infectious Agents and Cancer 2017;12:19. DOI: 10.1186/s13027-017-0129-6
14. Udager AM, McHugh JB. Human Papillomavirus–Associated Neoplasms of the Head and Neck. Surgical Pathology Clinics 2017;10(1):35-55. DOI: 10.1016/j.path.2016.10.007
15. Mehanna H, Beech T, Nicholson T et al. Prevalence of human pap-illomavirus in oropharyngeal and nonoropharyngeal head and neck cancer—systematic review and meta‐analysis of trends by time and re-gion. Head and Neck 2013;(35):747-755. DOI: 10.1002/hed.22015
16. Grulich AE, Poynten IM, Machalek DA et al. The epidemiology of anal cancer. Sexual Health 2012;9:504-508. DOI: 10.1071/SH12070
17. Smittenaar CR, Petersen KA, Stewart K et al. Cancer incidence and mortality projections in the UK until 2035. British Journal of Cancer 2016;115:1147. DOI: 10.1038/bjc.2016.304
18. Daling JR, Madeleine MM, Johnson LG et al., Human papilloma-virus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004; 101:270-80. DOI: 10.1002/cncr.20365
19. CDC. How Many Cancers Are Linked with HPV Each Year? https://www.cdc.gov/cancer/hpv/statistics/cases.htm (accessed 22 February 2019).
20. Cancer Research UK. Penile cancer incidence statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/penile-cancer/incidence#heading-Two (accessed 22 February 2019).
21. Patel H, Wagner M, Singhal P et al. Systematic review of the inci-dence and prevalence of genital warts. BMC Infectious Diseases 2013;13:39. DOI :10.1186/1471-2334-13-39
22. Giuliano AR, Sirak B, Abrahamsen M et al. Genital Wart Recur-rence Among Men Residing in Brazil, Mexico, and the United States. The Journal of Infectious Diseases 2019;219(5) 703–710. DOI: 10.1093/infdis/jiy533
23. Omland T, Lie KA, Akre H et al. Recurrent Respiratory Papilloma-tosis: HPV Genotypes and Risk of High-Grade Laryngeal Neoplasia. PLoS ONE 2014;9(6):e99114. DOI: 10.1371/journal.pone.0099114
24. Russo GI, Calogero AE, Condorelli RA et al. Human papilloma-virus and risk of prostate cancer: a systematic review and meta-analysis, The Aging Male 2018;March 23:1-7. DOI: 10.1080/13685538.2018.1455178
25. Ragin C, Obikoya-Malomo M, Kim S. HPV-associated lung cancers: an international pooled analysis. Carcinogenesis 2014;35(6): 1267-1275. DOI: 10.1093/carcin/bgu038
26. Joo E-J, Chang Y, Kwon M-J et al. High-Risk Human Papillomavirus Infection and the Risk of Cardiovascular Disease in Korean Women: A Cohort Study. Circulation Research 2019;February 7. DOI: 10.1161/CIRCRESAHA.118.313779
27. WHO (2018). Global Market Study: HPV. https://www.who.int/immunization/programmes_systems/procurement/v3p/platform/module2/WHO_HPV_market_study_public_summary.pdf (accessed 18 February 2019).
28. Sankaranarayanan R, Joshi S, Muwonge R et al. Can a single dose of human papillomavirus (HPV) vaccine prevent cervical cancer? Ear-ly findings from an Indian study. Vaccine 2018;36(32)(A):4783-4791. DOI: 10.1016/j.vaccine.2018.02.087.
29. WHO. Weekly epidemiological record No 19.. 2017(92):241-268. https://apps.who.int/iris/bitstream/handle/10665/255353/WER9219.pdf;jsessionid=F4E1B9097392348750190326B3275A65?sequence=1 (accessed 22 February 2019).
30. Bruni L, Diaz M, Barrionuevo-Rosas L et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet 2016;4(7):PE453-E463. DOI: 10.1016/S2214-109X(16)30099-7
31. World Bank. World Bank Country and Lending Groups. Country Classification.http://databank.worldbank.org/data/download/site-content/CLASS.xls (accessed 18 February 2019).
32. Luyten, J., Engelen B, Beutels P. The Sexual Ethics of HPV Vaccination for Boys. HEC Forum 2014;26:27. DOI: 10.1007/s10730-013-9219-z
33. Salisbury DM. Male vaccination against human papillomavirus. Lancet 2012;12(8):582-583. DOI: 10.1016/S1473-3099(12)70082-8
34. Favato G, Easton T, Vecchiato R et al. Ecological validity of cost-effectiveness models of universal HPV vaccination: a systematic litera-ture review. Vaccine 2017;35(20):2622-2632. DOI: 10.1016/j.vaccine.2017.03.093
35. Shapiro GK, Perez S, Rosberger Z. Including males in Canadian human papillomavirus vaccination programs: a policy analy-sis. Canadian Medical Association Journal 2016;188(12):881-6. DOI: 10.1503/cmaj.150451
36. Diamond LM. Sexual Fluidity in Male and Females. Current Sexual Health Reports 2016;8:249. DOI: 10.1007/s11930-016-0092-z
37. Robinson S, Anderson E, White A. The Bromance: Undergraduate Male Friendships and the Expansion of Contemporary Homosocial Boundaries. Sex Roles 2018;78:94. DOI: 10.1007/s11199-017-0768-5
38. Prue G. Human papillomavirus: a strong case for vaccinating boys. Trends in Urology and Men’s Health 2016;7(1):7-10.
39. Bruni L, Diaz M, Barrionuevo-Rosas L, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Global Health 2016; 4: e453–63. DOI: 10.1016/S2214-109X(16)30099-7.
40. MSD (2018). Variation in uptake of the HPV National Immunisa-tion Programme (MSD, UK).
41. Mercer CH, Tanton C, Prah P et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet 2013;383(9907):1781-1794. DOI: 10.1016/S0140-6736(13)62035-8
42. Haeussler K, Marcellusi A, Mennini FS et al. Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study. Value in Health 2015;18(8)956-968. DOI: 10.1016/j.jval.2015.08.010
43. The National Institute for Health and Welfare. The National Institute for Health and Welfare recommends including the HPV vaccine in the boys’ vaccination programme. https://thl.fi/en/web/thlfi-en/-/the-national-institute-for-health-and-welfare-recommends-including-the-hpv-vaccine-in-the-boys-vaccination-programme (accessed 22 February 2019).
44. Graham DM, Isaranuwatchai W , Habbous S yet al. A cost‐effectiveness analysis of human papillomavirus vaccination of boys for the prevention of oropharyngeal cancer. Cancer 2015; 121:1785-1792. DOI: 10.1002/cncr.29111
45. WHO. Weekly epidemiological record No 19.. 2017(92):241-268. https://apps.who.int/iris/bitstream/handle/10665/255353/WER9219.pdf;jsessionid=F4E1B9097392348750190326B3275A65?sequence=1 (accessed 22 February 2019).
46. Chido-Amajuoyi OG, Domgue JF, Obi-Jeff C et al. A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa. Lancet Global Health 2019;7(1):PE20-E21. DOI: 10.1016/S2214-109X(18)30405-4
47. Public Health England (2018). Annual HPV vaccine coverage in England 2017 to 2018: data by local authority and local team. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/760900/HPV_2017_2018_annual_data_tables.xlsx
48. Prue G, Baker P, Graham D et al. It is time for universal vaccination. Lancet 2018;392(10151):913-914. DOI: 10.1016/S0140-6736(18)31821-X
49. Merriel SWD, Nadarzynski T, Kesten JM et al. 'Jabs for the boys': time to deliver on HPV vaccination recommendations. British Journal of General Practice 2018;68(674):406-407. DOI: 10.3399/bjgp18X698429
50. Prue G, Graham D, Shapiro G et al. Universal HPV vaccination – a global prerogative. International Journal of Men’s Social and Community Health 2018;Vol 1(1):e14-e22.
51. Prue, G, Lawler, M, Baker P et al. (2016) Human Papillomavirus (HPV): Making the case for “Immunisation for All”. Oral Diseases 2017;23(6):726-730. DOI: 10.1111/odi.12562
52. Prue G. Human papillomavirus: a strong case for vaccinating boys. Trends in Urology and Men's Health 2016;7(1): 7-10.
53. Baker P. HPV vaccination: is it time for jabs for the boys?’ Health Europa Quarterly 2018(5):120-121.
54. Prue G, Graham D, Banks I et al. Re: Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis. BMJ 2015;350:h2016. DOI:
55. Prue G. Vaccinate boys as well as girls against HPV: it works and it may be cost-effective. BMJ 2014;349:g4834. DOI: 10.1136/bmj.g4834
56. Baker P. ‘Jabs for the boys: the case for gender-neutral HPV vac-cination’. Perspectives in Public Health 2016:136:28-29. DOI: 10.1177/1757913915616729
57. Ong KJ, Checchi M, Burns L et al. Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates. Sexually Transmitted Infections 2019;95:28-35. DOI: 10.1136/sextrans-2018-053606
58. Favato G, Easton T, Vecchiato R et al. Ecological validity of cost-effectiveness models of universal HPV vaccination: a systematic litera-ture review. Vaccine 2017;35:20:2622-2632 DOI:10.1016/j.vaccine.2017.03.093
59. Choi EPH, Wong JYH, Lo HHM et al. The association between smartphone dating applications and college students' casual sex en-counters and condom use. Sexual and Reproductive Healthcare 2016;9:38-41. DOI: 10.1016/j.srhc.2016.07.001.
60. Lewis R, Tanton C, Mercer CH. Heterosexual Practices Among Young People in Britain: Evidence From Three National Surveys of Sexual Attitudes and Lifestyles. Journal of Adolescent Health 2017;61:694e702. DOI: 10.1016/j.jadohealth.2017.07.004
61. HPV Action (2016). Jabs for the Boys: The case for gender-neutral HPV vaccination. HPV Action; Rugby, UK.
62. WHO. Safety update of HPV vaccines. https://www.who.int/vaccine_safety/committee/topics/hpv/June_2017/en/ (accessed 22 February 2019).
63. UK Parliament. House of Commons Hansard 2 May 2018. https://hansard.parliament.uk/commons/2018-05-02/debates/234E27F7-7D80-4B93-A72F-8F36A733A504/HPVVaccinationForBoys (accessed 26 February 2019).