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\begin{document}

\title{Prioritizing equitable access to Human Papillomavirus (HPV) vaccination
for MSM in Africa: Addressing disparities in disease prevention and
control}



\author[1]{Ejovwokeoghene Omohwovo}%
\affil[1]{University of Port Harcourt Faculty of Natural and Applied Sciences}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\textbf{}Sexually transmitted infections (STIs) are a major global
public health concern, with human papillomavirus (HPV) being one of the
most common STIs affecting both men and women worldwide {[}1{]}. It is
estimated that about 75\% of sexually active people will contract HPV at
some point in their lives {[}1{]}. The impact of HPV on health can be
severe, causing various health problems such as genital warts, cervical,
anal, penile, and oropharyngeal cancers {[}2{]}.

Several studies conducted in Africa have shown significant HPV
prevalence rates among men who have sex with men (MSM). In sub-Saharan
Africa, HPV was detected in a range of 19.1\% to 100\% of men, with a
pooled prevalence of 78.2\% among HIV-positive men and 49.4\% among
HIV-negative men {[}3{]}. Another study in South Africa found that HPV
genotypes were detected in 72.8\% of anal, 11.5\% of oro-pharyngeal, and
15.3\% of urine specimens of MSM, with multiple HPV types being more
common in the anal canal {[}4{]}. Additionally, a study in Nigeria
reported a higher prevalence of anal high-risk HPV (HR-HPV) among
HIV-positive MSM compared to HIV-negative MSM {[}5{]}, while another
study in Mali found that a significant percentage of MSM had anal HPV
infection of any genotypes, with a large portion being HR-HPV positive
{[}6{]}. The increasing prevalence of anal HR-HPV among MSM in Africa
highlights the urgent need for increased HPV screening and prevention
measures targeted at this population, particularly HIV-positive MSM.

HPV vaccination programs are highly effective in reducing the burden of
HPV and associated diseases in both men and women {[}3{]}. The vaccine
offers long-lasting protection against HPV infections that are most
commonly associated with cancer {[}7{]}. Although the vaccine is
primarily known for preventing cervical cancer in women, it can also
prevent HPV-related cancers in men, such as anal, penile, and
oropharyngeal cancers {[}7{]}. Moreover, vaccinating men can lead to
herd immunity, which can protect women from HPV-related diseases
{[}2{]}. Therefore, it is essential to prioritize the HPV vaccine for
MSM who engage in anal sex to prevent HPV-related cancers and reduce the
overall burden of HPV in Africa.

However, the low uptake of the HPV vaccine in Africa, especially among
high-risk individuals, is concerning despite the vaccine's effectiveness
in preventing HPV-related diseases. Only 14 of the 54 African nations
have included the HPV vaccine in their national immunization programs
for girls as of 2021, and no countries in western and central Africa
have included widespread HPV vaccination in their national immunization
programs {[}8 10{]}. Furthermore, currently, no countries in Africa
offer HPV vaccination to men {[}8{]}. This means that individuals
engaging in anal sex, who are at a higher risk of developing anal
cancer, are not receiving the protection they need, despite the high
prevalence of HPV infection among MSM. This underscores the urgent need
to prioritize the inclusion of the HPV vaccine in national immunization
programs in Africa, and to ensure equitable access to the vaccine for
all persons, including MSM.

To improve access to healthcare services and HPV vaccination for MSM in
Africa, it is crucial to address both the structural and social barriers
that hinder their access to these services. Some of the barriers that
HPV-infected MSM face include a lack of information, general vaccine
hesitancy, a lack of advice from healthcare professionals, expense and
logistics, and the perception that HPV vaccination may encourage
promiscuity {[}9{]}. Furthermore, discrimination and the criminalization
of same-sex behavior can further prevent MSM from accessing healthcare
programs {[}10{]}.

A comprehensive approach is necessary to overcome these barriers and
improve access to healthcare services and HPV vaccination for MSM in
Africa. This includes community-based interventions {[}11{]}, and
healthcare professional training to increase awareness about HPV, the
benefits of vaccination, and to reduce vaccine hesitancy among MSM
{[}12{]}. Healthcare professionals should also receive training to
provide culturally competent care to meet the unique healthcare needs of
MSM in a non-judgmental manner {[}12{]}. Policy changes are also
necessary to eliminate discrimination and criminalization of same-sex
behavior and enable MSM to access healthcare services without fear of
stigma or persecution {[}10{]}. Moreover, to increase vaccine coverage
in Africa, the HPV vaccine should be made affordable and accessible to
all individuals, regardless of their socioeconomic status {[}10{]}. This
can be achieved by implementing community-based vaccination programs,
mobile clinics, and school-based vaccination programs. Overall, these
interventions can help to improve vaccination rates and increase access
to healthcare services for MSM in Africa, ultimately leading to better
health outcomes and reducing health disparities.

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