Exploring the Barriers to HPV Vaccination Among Males in Italy: A Qualitative Study
1
London School of Hygiene and Tropical Medicine, London, United Kingdom
2
UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases, Department of Prevention, Local Health Authority (AST Ancona), Jesi, Italy
3
Department of translational research and new technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
4
Department of Prevention, Local Health Unit, Lecce, Italy
5
Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
6
Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Human papillomavirus (HPV) causes a substantial burden of cancers in both sexes. Although Italy adopted gender-neutral HPV vaccination in 2017, male coverage remains persistently below national targets, including Marche region. This study assessed current policies supporting male HPV vaccination and explored stakeholder perspectives on barriers and facilitators to improve equitable uptake.
METHODS:
A sequential mixed-methods design was used. First, a policy review analysed two National Immunization Prevention Plans (PNPV 2017–2019; PNPV 2023–2025) and 21 regional/provincial documents (2017–2024) to map eligibility, implementation approaches, and heterogeneity in free access for males. Second, semi-structured online interviews (Microsoft Teams) were conducted in Italian with 13 key informants (6 Marche; 7 other regions) between August–September 2025, including policymakers, public health officials, and clinicians. Transcripts were analysed using thematic and framework analysis.
RESULTS:
The policy review showed marked regional variation in male eligibility for free HPV vaccination, with upper age limits ranging from 18 years to lifelong access and differences in eligible birth cohorts. Interviews identified seven interlinked themes: (1) female-centred communication framing HPV vaccination primarily as cervical cancer prevention; (2) low risk perception for males and adolescent vaccine hesitancy; (3) insufficient, discontinuous institutional communication and limited direct engagement of adolescents; (4) divergent feasibility views on school-based vaccination despite perceived effectiveness; (5) weak and fragmented catch-up pathways for males due to limited routine healthcare contacts; (6) strong support for a single-dose schedule to reduce drop-out, alongside scepticism about lowering the start age to 9 years; and (7) the need for national harmonisation, funded communication plans, and resourced recall systems.
CONCLUSIONS:
Suboptimal male HPV vaccination in Italy reflects fragmented regional implementation and persistent sociocultural and communication barriers. Strengthening gender-neutral messaging, investing in reminder/recall and outreach, and aligning regional eligibility and delivery strategies are key to improving male uptake.
Human papillomavirus (HPV) causes a substantial burden of cancers in both sexes. Although Italy adopted gender-neutral HPV vaccination in 2017, male coverage remains persistently below national targets, including Marche region. This study assessed current policies supporting male HPV vaccination and explored stakeholder perspectives on barriers and facilitators to improve equitable uptake.
METHODS:
A sequential mixed-methods design was used. First, a policy review analysed two National Immunization Prevention Plans (PNPV 2017–2019; PNPV 2023–2025) and 21 regional/provincial documents (2017–2024) to map eligibility, implementation approaches, and heterogeneity in free access for males. Second, semi-structured online interviews (Microsoft Teams) were conducted in Italian with 13 key informants (6 Marche; 7 other regions) between August–September 2025, including policymakers, public health officials, and clinicians. Transcripts were analysed using thematic and framework analysis.
RESULTS:
The policy review showed marked regional variation in male eligibility for free HPV vaccination, with upper age limits ranging from 18 years to lifelong access and differences in eligible birth cohorts. Interviews identified seven interlinked themes: (1) female-centred communication framing HPV vaccination primarily as cervical cancer prevention; (2) low risk perception for males and adolescent vaccine hesitancy; (3) insufficient, discontinuous institutional communication and limited direct engagement of adolescents; (4) divergent feasibility views on school-based vaccination despite perceived effectiveness; (5) weak and fragmented catch-up pathways for males due to limited routine healthcare contacts; (6) strong support for a single-dose schedule to reduce drop-out, alongside scepticism about lowering the start age to 9 years; and (7) the need for national harmonisation, funded communication plans, and resourced recall systems.
CONCLUSIONS:
Suboptimal male HPV vaccination in Italy reflects fragmented regional implementation and persistent sociocultural and communication barriers. Strengthening gender-neutral messaging, investing in reminder/recall and outreach, and aligning regional eligibility and delivery strategies are key to improving male uptake.
| eISSN: | 2654-1459 |
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