Closing the gaps in HPV

Closing The Gaps: What we have learned about HPV vaccination in Cheshire and Merseyside – and what happens next

By Nicky Hutton, Eluned Hughes and Dave Bowler

 

Human papillomavirus (HPV) is something many people have heard of, yet few fully understand. It’s incredibly common – around 8 in 10 of us will encounter HPV at some point in our lives, but without any symptoms – and for most people, it causes no harm at all.

But persistent infection with certain high-risk HPV types can lead to cancers, including cervical, anal, penile, vulval, vaginal, and some head and neck cancers. The good news? The HPV vaccine is a highly effective way to prevent these cancers and is available free on the NHS for several groups.

But uptake isn’t where it needs to be. Understanding why is crucial to Cheshire and Merseyside Cancer Alliance’s (CMCA) mission to improve vaccination coverage and reduce cancer inequalities across the region. That’s why, through a blend of desk research, surveys, stakeholder engagement and insight from frontline organisations, CMCA has explored what’s helping – and what’s hindering – HPV vaccination uptake across Cheshire and Merseyside.

This blog summarises what we found, what it means for our communities, and what CMCA is committing to next.

 

Why CMCA studied HPV vaccination

The HPV vaccination programme is well established for 12–13-year-olds in schools (girls since 2008 and boys since 2019), but isn’t always taken up, leading to gaps in adulthood.

Importantly, adult women and men aged up to 25 and at-risk groups, such as gay, bisexual and other men who have sex with men (GBMSM), people living with HIV, transgender people and sex workers, are also eligible for free vaccination through GPs and sexual health clinics, respectively. Despite this, public awareness remains low, and vaccination rates are lower than in other areas of the country.

CMCA wanted to understand local barriers, learn from national evidence, and bring together the people who work closest with communities – from primary care and sexual health providers to third-sector organisations and patient representatives – to create a clearer, evidence-led way forward.

This work included:

• Desktop research reviewing academic and policy evidence

• A local survey with GBMSM in Cheshire and Merseyside (via One Wirral and Sahir House)

• Analysis of a national GBMSM survey conducted via Grindr, including localised North West data.

• A stakeholder workshop with healthcare professionals, patient representatives and charities from across the region.

Together, the above suggest what may need to change.

 

What we found: Barriers that cut across all groups

Although different cohorts face distinct challenges, several barriers repeatedly emerged across our research.

Low awareness and understanding

Perhaps the most significant finding is how little the public knows about HPV vaccination eligibility. A YouGov study found:

• Only 22% knew women under 25 are eligible

• Only 9% knew men are eligible up to 25

• Just 14% were aware that high-risk groups are eligible up to age 45.

Among the GBMSM community – a group at increased risk of HPV related cancers – understanding is still low. In the local survey:

• 63% had heard of the vaccine

• Only 18% felt they had a good understanding of it

• 71% didn’t know they were eligible up to age 45 via sexual health clinics

This shows a clear message gap. People won’t take up a vaccine if they don’t know they are eligible for it.

Difficulties accessing healthcare

Practical barriers remain a very real issue. These include:

• Inconvenient appointment times

• Poor awareness of where to get the vaccine

• Variable GP practice HPV vaccine availability, with some practices not routinely stocking.

Some GBMSM avoid engaging with healthcare overall due to stigma or fears about discussing sexual orientation/preferences – something highlighted in both local and national survey data.

Vaccine hesitancy and stigma

Concerns about needles, side effects, and misconceptions about the vaccine still hold people back. For some communities, there are also cultural considerations, such as worry that vaccines may not be halal or kosher.

In school-aged cohorts, some parents remain concerned that the vaccine is linked to early sexual activity – a misconception repeatedly challenged in evidence reviews.

Limited visibility for adult cohorts

While uptake in schools is monitored nationally, data for adults – particularly GBMSM – is not well understood. This makes it harder for the system to target interventions effectively.

Improving data is essential to making sure no communities fall through the gaps.

 

What the GBMSM population told us: Insights from community surveys

Understanding the barriers and motivators within GBMSM communities is central to CMCA’s role. These insights show that while awareness is rising, confusion remains.

Key barriers from the local GBMSM survey:

• 55% didn’t see the vaccine as important

• 53% felt stigma because the vaccine is linked to sexual health

• 39% believed it “wasn’t for them”

• 26% had concerns about side effects

• Many struggled with clinic availability, especially outside working hours.

These reinforced the need for culturally sensitive messaging that speaks directly to GBMSM experiences – not generic vaccination language.

Key facilitators:

Respondents said they would be more likely to get vaccinated if they had:

• Clear explanations (61%)

• Real stories from people like them (58%)

• Trusted locations to receive the vaccine (50%)

• Evening/weekend appointments (42%)

• Recommendations from trusted community voices (37%).

The insight is decisive: information needs to be simple, honest, and relatable, and services need to offer flexible appointments outside traditional hours to support uptake.

 

What the National GBMSM Survey showed

The Grindr-based survey added a broader perspective, with 644 responses across the UK and 53 from the North West.

Awareness remains a major barrier: a third of respondents didn’t know they were eligible. A fifth didn’t know where to get the vaccine. Appointment times were also an issue.

Where people feel most comfortable getting vaccinated:

Nationally:

• 47% preferred sexual health clinics

• 30% preferred GP surgeries.

In the North West:

• sexual health clinics: 40%

• GP surgeries: 45%.

This highlights the need to explore expanding opportunities for where people can be vaccinated, ultimately making the process less restrictive.

What we heard from stakeholders across Cheshire and Merseyside

At our October 2025 workshop, 50 people from healthcare, education, third sector organisations, and patient groups came together to identify practical barriers and co-design solutions.

Across the discussions, several key themes emerged.

Awareness and knowledge

Professionals reported:

• Widespread misconceptions

• Cultural taboos

• Stigma linked to sexual health

• Lack of tailored messaging that reflects the diversity of communities

Accessibility

Many raised issues, such as:

• Limited clinic hours

• Travel difficulties

• Need for vaccination in community-based settings (e.g., workplaces, supermarkets, LGBTQ+ venues).

Policy and commissioning barriers

Stakeholders highlighted:

• Inflexible delivery models

• Commissioning delays

• Missed opportunities during routine appointments when vaccination isn’t offered opportunistically.

Social and Cultural Barriers

These included:

• Fear of needles

• Stigma

• Mistrust in healthcare among some groups

• Social anxiety or fear of being “seen” in a sexual health setting

• Language barriers and lack of interpreters.

The message was clear: improving vaccination is as much about trust, representation, and inclusivity as it is about logistics.

 

Turning insight into action: CMCA’s plans

CMCA has utilised these insights and incorporated them into its three-year HPV Vaccination Programme. Encompassing four key workstreams, the programme is driven by the following aims:

1. To be data-driven in identifying vaccination gaps, monitor uptake progress across the region and inform targeted interventions. While increasing visibility for healthcare and population health professionals by incorporating available existing HPV vaccination data into CMCA’s PRACTICE Dashboard

2. Enhancing communication, education and awareness of HPV amongst all stakeholders and eligible cohorts

3. Improving HPV vaccine access through supporting the development of new delivery models

4. A targeted GBMSM campaign to enhance awareness amongst this at-risk cohort

These aims will drive four workstreams, each of which is identified and discussed further below.

 

What this means for Cheshire and Merseyside

HPV vaccination is an extraordinary tool for contributing to the prevention of several cancers – but to have the greatest impact, it must be accessible, understood, and trusted by our communities.

This insight work makes it clear that:

• Awareness remains too low

• Access is perceived to be too difficult for many

• Messaging needs to be more inclusive and more visible

• Adult cohorts – including GBMSM – need specific, targeted approaches

• Community organisations have a vital role in reaching underserved groups

• People want clear information, relatable stories, and easy access.

Most importantly, it shows that improving HPV vaccination uptake isn’t just about service delivery. It’s about equity, representation, and breaking down stigma.

 

What happens next?

CMCA is currently devising its plans with stakeholders to roll out over the next three years across the region. There are working groups for each of the four workstreams, comprising healthcare and public health professionals, charitable-sector partners and patient representatives with lived experience/knowledge of HPV and related cancers.

 

Conclusion

HPV vaccination has the power to contribute to the prevention of several cancers (the eradication of cervical cancer) and save lives. To make that a reality for everyone, we need to understand – and address – the real-world barriers people face. Thanks to the combined insights from research, surveys, and stakeholders, CMCA now has a richer, more honest picture of the barriers.