The influence of human papilloma virus vaccination on sexual behavior of adolescent girls: A case study of Nakasongola and Luwero Districts

Abstract

INTRODUCTION: Human Papilloma Virus (HPV) the cause of cervical cancer is known to be spread through sexual contact. Vaccination against HPV before sexual debut was recommended by WHO as a way of primary prevention of cervical cancer. In Uganda, vaccination against HPV started in 2008 as a pilot for girls in Nakasongola and Ibanda districts. Some studies have suggested that vaccination against HPV might lead to risky sexual behavior and increase the risk of early sexual debut among vaccinated girls. However this has not been assessed and there is a knowledge gap on whether vaccination has any influence on sexual behavior of vaccinated girls in Uganda. OBJECTIVES: To describe sexual behavior and factors which influence sexual behavior of HPV vaccinated and non vaccinated adolescent girls. METHODS: The study was an un-matched comparative study using both qualitative and quantitative methods. It was carried out between 6th to 16th February 2011 among primary school girls aged 12 to 15 years in Nakasongola (vaccinated) and Luwero (non vaccinated) districts. Questionnaires were given to four hundred girls, 200 from each district. Six FGDs were held with another 52 girls, and 5 key informant interviews were conducted. Data on sociodemographics, HPV vaccine knowledge and sexual behavior was collected. Quantitative data was entered using EPI INFO version 3.4.1 and analyzed using SAS version 12. Qualitative data was analyzed manually in four preset themes. Outcome measures were number of sexually active girls in each group and assessment of influence of HPV vaccination on sexual behavior of vaccinated girls. RESULTS: Of the 400 girls, 5(2.5%) from Luwero and 3 (1.5%) from Nakasongola were found to be sexually active. The prevalence of dating was 19.5% in Luwero and 9.55% in Nakasongola. HPV vaccination was not significantly associated with being sexually active. Sexually active girls were more likely to be dating (p value <0.0001). Qualitative results indicated that HPV vaccination was not thought to influence sexual behavior of the girls. Other factors reported to influence behavior were old age, peer pressure, poverty, being lured with gifts and abscence of parents. CONCLUSION: There was no difference in sexual behavior between vaccinated and non vaccinated girls. Factors that were found to influence sexual behavior were old age, poverty, peer influence and dating. Prior sex education was protective. RECOMMENDATIONS: HPV vaccination should be promoted because it does not lead to early sexual debut or risky sexual behavior. Sex education should be provided to promote abstinence and to improve knowledge about HPV and other STDs. A follow-up cohort study of vaccinated girls should be conducted to determine if there is any delayed influence of the vaccination on sexual behavior.