Evaluation of Human Papillomavirus Vaccination and Cancer Prevention Behaviors Among LGBTQI + Individuals: A Cross-Sectional Study

Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.