{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:28:47Z","timestamp":1785403727403,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015671","name":"Duke Kunshan University","doi-asserted-by":"publisher","award":["00AKUG0130"],"award-info":[{"award-number":["00AKUG0130"]}],"id":[{"id":"10.13039\/501100015671","id-type":"DOI","asserted-by":"publisher"}]},{"award":["00AKUG0130"],"award-info":[{"award-number":["00AKUG0130"]}],"id":[{"id":"https:\/\/ror.org\/04sr5ys16","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Men who have sex with men (MSM) experience a disproportionate burden of human papillomavirus (HPV)-related disease, yet vaccination uptake remains uneven. With MSM as the key population of interest, this review synthesized evidence on uptake, willingness, multilevel barriers and opportunities, and vaccine-oriented outcomes among MSM and related sexual and gender minority populations when MSM-relevant findings could be extracted. Methods: Six databases were searched for original English- or Chinese-language studies published from 1 January 2010 to 31 December 2025. Findings were synthesized narratively. Barriers and opportunities were mapped using a five-level socio-ecological model; study-level willingness\u2013uptake patterns were explored using K-means clustering as an exploratory analysis among the nine studies reporting both outcomes; and genotype-specific and immunogenicity findings were summarized separately. Results: Fifty-three studies involving 169,241 participants were included; 87.2% of participants were MSM, and 79% of studies were cross-sectional. Barriers and opportunities occurred across individual, provider-related interpersonal, organizational\/institutional, community, and policy\/societal levels. Recurrent paired mechanisms involved knowledge and trust, provider recommendation and communication, service accessibility, community support, and eligibility and affordability. Nine studies contributed data to the exploratory clustering analysis; seven fell into low-uptake clusters, including three with high willingness but low uptake, which may indicate a possible study-level implementation gap. Two studies reporting genotype prevalence and antibody responses provided limited biological context supporting vaccination before exposure and suggesting potential benefit from catch-up vaccination. Discussion: Among MSM and related sexual and gender minority populations, HPV vaccination is shaped by interacting individual and structural conditions, with MSM remaining the principal focus of the evidence base. Improving uptake is likely to require complementary strategies: universal, gender-neutral routine vaccination in adolescence before their sexual debut, and targeted catch-up for MSM who missed routine vaccination, supported by trusted provider endorsement, convenient service delivery, community engagement, and inclusive, affordable policy. The thematic counts were study-level and unweighted, and the nine-study clustering analysis was exploratory rather than definitive.<\/jats:p>","DOI":"10.3390\/vaccines14070632","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Opportunities and Barriers to HPV Vaccination Among Men Who Have Sex with Men and Related Sexual and Gender Minority Populations: A Systematic Review and Exploratory Clustering Analysis Using a Socio-Ecological Framework"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7256-4087","authenticated-orcid":false,"given":"Jiayu","family":"Cai","sequence":"first","affiliation":[{"name":"Division of Natural and Applied Sciences, Duke Kunshan University, Kunshan 215316, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4145-386X","authenticated-orcid":false,"given":"Zhuohang","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Natural and Applied Sciences, Duke Kunshan University, Kunshan 215316, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Zuo","sequence":"additional","affiliation":[{"name":"Division of Natural and Applied Sciences, Duke Kunshan University, Kunshan 215316, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8360-9537","authenticated-orcid":false,"given":"Yiu Wing","family":"KAM","sequence":"additional","affiliation":[{"name":"Division of Natural and Applied Sciences, Duke Kunshan University, Kunshan 215316, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1038\/s41579-021-00617-5","article-title":"Human Papillomaviruses: Diversity, Infection and Host Interactions","volume":"20","author":"McBride","year":"2022","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1056\/NEJMoa021641","article-title":"Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer","volume":"348","author":"Bosch","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_3","unstructured":"(2026, June 10). Cervical Cancer. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16086","DOI":"10.1038\/nrdp.2016.86","article-title":"Carcinogenic Human Papillomavirus Infection","volume":"2","author":"Schiffman","year":"2016","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zhang, D.-Y., Yin, Y.-P., Feng, T.-J., Hong, F.-C., Jiang, N., Wang, B.-X., and Chen, X.-S. (2014). HPV Infections among MSM in Shenzhen, China. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096364"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/cncr.20364","article-title":"Anal Cancer Incidence and Survival: The Surveillance, Epidemiology, and End Results Experience, 1973\u20132000","volume":"101","author":"Johnson","year":"2004","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1080\/21645515.2016.1157673","article-title":"Comparing Human Papillomavirus Vaccine Knowledge and Intentions among Parents of Boys and Girls","volume":"12","author":"Lindley","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cao, K., and Kam, Y.-W. (2025). Literature Review and Policy Recommendations for Single-Dose HPV Vaccination Schedule in China: Opportunities and Challenges. Vaccines, 13.","DOI":"10.3390\/vaccines13080786"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An Ecological Perspective on Health Promotion Programs","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ. Q."},{"key":"ref_11","unstructured":"MacQueen, J. (1967). Some Methods for Classification and Analysis of Multivariate Observations, University of California Press."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/cid\/ciab1052","article-title":"Human Papillomavirus Antibody Levels Following Vaccination or Natural Infection Among Young Men Who Have Sex with Men","volume":"75","author":"Chow","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6271","DOI":"10.1016\/j.vaccine.2019.08.066","article-title":"Anal Human Papillomavirus Infections in Young Unvaccinated Men Who Have Sex with Men Attending a Sexual Health Clinic for HPV Vaccination in Melbourne, Australia","volume":"37","author":"Chow","year":"2019","journal-title":"Vaccine"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lun, P., Gao, J., Tang, B., Yu, C.C., Jabbar, K.A., Low, J.A., and George, P.P. (2022). A Social Ecological Approach to Identify the Barriers and Facilitators to COVID-19 Vaccination Acceptance: A Scoping Review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0272642"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100180","DOI":"10.1016\/j.ssmqr.2022.100180","article-title":"Applying a Social-Ecological Model to Understand Factors Impacting Demand for Childhood Vaccinations in Nigeria, Uganda, and Guinea","volume":"2","author":"Bell","year":"2022","journal-title":"SSM-Qual. Res. Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ferrer, H.B., Trotter, C., Hickman, M., and Audrey, S. (2014). Barriers and Facilitators to HPV Vaccination of Young Women in High-Income Countries: A Qualitative Systematic Review and Evidence Synthesis. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-700"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1001\/jamapediatrics.2013.2752","article-title":"Barriers to Human Papillomavirus Vaccination Among US Adolescents","volume":"168","author":"Holman","year":"2014","journal-title":"JAMA Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e255","DOI":"10.1097\/OLQ.0000000000001407","article-title":"Barriers to and Facilitators of Human Papillomavirus Vaccination Among People Aged 9 to 26 Years: A Systematic Review","volume":"48","author":"Zheng","year":"2021","journal-title":"Sex. Transm. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.vaccine.2016.01.023","article-title":"Provider Communication and HPV Vaccination: The Impact of Recommendation Quality","volume":"34","author":"Gilkey","year":"2016","journal-title":"Vaccine"},{"key":"ref_20","unstructured":"(2026, June 09). CDC Outreach to Clinicians, Available online: https:\/\/www.cdc.gov\/hpv\/php\/outreach-to-clinicians\/index.html."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5065","DOI":"10.1016\/j.vaccine.2018.06.075","article-title":"Men Who Have Sex with Men Who Do Not Access Sexual Health Clinics nor Disclose Sexual Orientation Are Unlikely to Receive the HPV Vaccine in the UK","volume":"36","author":"Nadarzynski","year":"2018","journal-title":"Vaccine"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Naidu, J., and Polonijo, A.N. (2023). Barriers and Facilitators to HPV and Meningococcal Vaccination among Men Who Have Sex with Men: A Qualitative Study. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-15847-w"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hanley, K., Chung, T.H., Nguyen, L.K., Amadi, T., Stansberry, S., Yetman, R.J., Foxhall, L.E., Bello, R., Diallo, T., and Le, Y.-C.L. (2023). Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients. Vaccines, 11.","DOI":"10.3390\/vaccines11040872"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kepka, D., Christini, K., McGough, E., Wagner, A., Del Fiol, G., Gibson, B., Ayres, S., Brandt, H.M., Mann, S., and Petrik, A.F. (2021). Successful Multi-Level HPV Vaccination Intervention at a Rural Healthcare Center in the Era of COVID-19. Front. Digit. Health, 3.","DOI":"10.3389\/fdgth.2021.719138"},{"key":"ref_25","unstructured":"(2026, June 09). Community-Led Responses|Results and Transparency Portal. Available online: https:\/\/open.unaids.org\/result-areas\/community-led-responses."},{"key":"ref_26","unstructured":"(2026, June 09). MSM: Men Who Have Sex with Men\u2014Action for AIDS (AfA Singapore). Available online: https:\/\/afa.org.sg\/what-we-do\/educational-programmes\/msm-men-who-have-sex-with-men\/."},{"key":"ref_27","unstructured":"Chesson, H.W., Meites, E., Ekwueme, D.U., Saraiya, M., and Markowitz, L.E. (2026, June 09). Cost-Effectiveness of HPV Vaccination for Adults Through Age 45 Years in the United States: Estimates from a Simplified Transmission Model, Available online: https:\/\/stacks.cdc.gov."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1080\/21645515.2015.1112474","article-title":"HPV Vaccination for MSM: Synthesis of the Evidence and Recommendations from the Qu\u00e9bec Immunization Committee","volume":"12","author":"Sauvageau","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1056\/NEJMoa0909537","article-title":"Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males","volume":"364","author":"Giuliano","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(19)30298-3","article-title":"Population-Level Impact and Herd Effects Following the Introduction of Human Papillomavirus Vaccination Programmes: Updated Systematic Review and Meta-Analysis","volume":"394","author":"Drolet","year":"2019","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1800055","DOI":"10.2807\/1560-7917.ES.2019.24.8.1800055","article-title":"Implementation and Evaluation of the Human Papillomavirus (HPV) Vaccination Pilot for Men Who Have Sex with Men (MSM), England, April 2016 to March 2017","volume":"24","author":"Edelstein","year":"2019","journal-title":"Euro Surveill."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:09:09Z","timestamp":1784534949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["vaccines14070632"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14070632","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}