# HPV knowledge and acceptance of HPV vaccination among men who have sex with men (MSM) in Germany: a multicenter, observational, cross-sectional study

## TL;DR

This study explores HPV knowledge and vaccination acceptance among men who have sex with men in Germany, finding low vaccination rates and identifying barriers like lack of information and reimbursement.

## Contribution

The study provides new insights into HPV vaccination awareness and hesitancy among MSM in Germany, highlighting the need for targeted information and policy changes.

## Key findings

- Only 13.7% of participants completed a full HPV vaccination schedule despite high awareness.
- Lack of information and no reimbursement for adult vaccination were major reasons for hesitancy.
- Physician recommendations and social networks could improve informed decision-making.

## Abstract

Men who have sex with men (MSM), especially those living with HIV, have a high prevalence of HPV infections that might lead to HPV-related diseases, including penile, oropharyngeal and anal carcinomas. Currently, beyond recommendations to get vaccinated during childhood, adult MSM are not included in the German national HPV vaccination recommendation. The aim of this cross-sectional study was to assess knowledge of HPV and HPV vaccination, and further acceptance and uptake of HPV vaccination among MSM in Germany.

Participants were recruited between 10/2023 and 07/2024 at 10 German study sites specialized on sexual and/or men’s health. Main inclusion criteria were being MSM, being aged 18–45 years and a German health insurance. Data were obtained through an electronic questionnaire and analyzed descriptively. 20 HPV and 5 HPV vaccination knowledge questions were evaluated using sum scores, with each correct answer scoring 1 point.

929 participants, aged 18–45 years (median 31), were included in the analysis. 122 (13.1%) were living with HIV and 717 (77.2%) used HIV-PrEP. 731 (78.7%) had prior knowledge of HPV, and 604 (65.0%) were aware of HPV vaccination. Mean sum scores for HPV knowledge (N = 731) and HPV vaccination knowledge questions (N = 604) were 13.3 ± 4.3 and 3.0 ± 1.3, respectively. Among those aware of HPV vaccination, 377 (62.4%) accepted vaccination (defined as already vaccinated (N = 204) or intending to get vaccinated (N = 173), and 223 (36.9%) participants were hesitant. Main reasons for hesitancy included a lack of information and no mandatory reimbursement of adult HPV vaccination costs. For MSM who intended to get vaccinated, payment out of pocket and missing physician recommendations were the main reasons for not being vaccinated yet. Among all analyzed MSM (N = 929), 127 (13.7%) completed a full vaccination schedule (21% within those aware of HPV vaccination).

Despite almost 80% participants being aware of HPV, vaccination uptake was low among all participants. More information about HPV, i.e., through physicians and social networks, might support informed decision-making. Further, facilitating access by offering reimbursement options for vaccination could potentially be a factor to help increase HPV vaccination uptake among MSM in Germany.

The online version contains supplementary material available at 10.1186/s12889-025-25746-x.