A Tale of Two Cohorts: Comparing HPV Vaccination Barriers and Facilitators Among HIV-Negative and HIV-Positive Women in Tennessee

Background: Human papillomavirus (HPV) continues to cause an estimated 4000 preventable cancer deaths each year in the United States. Given the prevalence of HPV-related disease and suboptimal vaccination rates, this study explores perceptions of HPV vaccination among HIV-negative females and females living with HIV in Tennessee. Methods: This prospective, observational qualitative study consisted of narrative interviews which were conducted with HIV-negative and HIV-positive participants, focusing on their perceptions of HPV and its vaccine. Interviews were conducted by phone, and the verbatim transcripts were inductively coded by three researchers. The inductive codes were then grouped into categories based on similarities which facilitated the emergence of themes. Results: A total of 40 participants were interviewed between July 2024 and December 2024. Narrative analysis revealed three themes: (1) “I had never heard of it until I saw the flier.” Gaps in Understanding of HPV and Its Health Implications, (2) Navigating Adolescent Health Decisions and Emotional Influence, and (3) Barriers to Uptake—Skepticism, Trust, and the Need for Tailored Information. Two subthemes emerged: Cohort-Specific Skepticism, and Parental Influence and Communication Gaps. Conclusions: This study revealed significant gaps in HPV knowledge and vaccination uptake among HIV-negative women and women living with HIV in Tennessee. Provider communication was key to vaccine decisions, but clear recommendations were often missed in clinical encounters.