Gender Matters: Informing HPV Vaccine Engagement in Serbia's Undergraduate Student Population

Abstract Background While HPV vaccination has primarily targeted girls aged 9-19, it also benefits young adults. In Serbia, free vaccination has been available since 2022, but uptake rates remain below 9%. Gender plays an important role in information seeking, trust, and drivers of vaccine behavior. A gender-sensitive approach is essential for designing effective interventions to promote HPV vaccine engagement. This study aimed to examine gender differences in undergraduate students’ HPV vaccine uptake, confidence in HPV vaccine safety and efficacy, and trust in HPV-related information sources. Methods An electronic questionnaire was administered from June to December 2024 to students receiving their second dose of the nonavalent HPV vaccine and those accessing general healthcare services at the Institute for Students’ Health of Belgrade. Confidence in HPV vaccine safety and efficacy, and trust in information sources were assessed using an instrument developed using the UNICEF Behavior Drivers Model. Results A total of 2005 students (78.2% females) completed the questionnaire. HPV vaccine uptake was higher among females (58.9% vs. 39.1%, p < 0.001). Female students expressed greater confidence in vaccine efficacy (M = 4.41 vs. M = 4.10, p < 0.001) and safety (M = 4.97 vs. M = 3.83, p < 0.001) compared to males. More females than males trusted scientific literature (75.9% vs. 68.2%, p < 0.01), family (53.9% vs. 43.3%, p < 0.01), friends (45.8% vs. 35.9%, p < 0.01), and chosen doctors (72.1% vs. 64.3%, p < 0.05) as information sources. Males were in larger proportion distrustful of social media (69.1% vs. 47.6%, p < 0.001) and in smaller proportion distrustful of government (64.1% vs. 72.1%, p < 0.05). Conclusions Gender significantly impacts HPV vaccine uptake, vaccine confidence and trust in information sources. HPV vaccination promotion strategies targeting young adults should account for these differences when designing educational messages and selecting communication channels. Key messages • Female university students in Serbia were in larger proportion vaccinated, show higher HPV vaccine confidence and trust in both formal and informal information sources. • Gender-transformative strategies are needed for HPV vaccination promotion in young adults, as vaccine perceptions and trust in information sources differ significantly between male and female students.