LAUSR

To the editor, Sexually transmitted infections (STIs) are a major global public health concern, with human papillomavirus (HPV) being one of the most common STIs affecting both men and women worldwide. It is estimated that about 75% of sexually active people will contract HPV at some point in their lives. The impact of HPV on health can be severe, causing various health problems such as genital warts, cervical, anal, penile, and oropharyngeal cancers. Several studies conducted in Africa have shown significant HPV prevalence rates among men who have sex with men (MSM). In sub‐Saharan Africa, HPV was detected in a range of 19.1% −100% of men, with a pooled prevalence of 78.2% among HIV‐positive men and 49.4% among HIV‐negative men. Another study in South Africa found that HPV genotypes were detected in 72.8% of anal, 11.5% of oro‐pharyngeal, and 15.3% of urine specimens of MSM, with multiple HPV types being more common in the anal canal. Additionally, a study in Nigeria reported a higher prevalence of anal high‐risk HPV (HR‐HPV) among HIV‐positive MSM compared to HIV‐negative MSM, while another study in Mali found that a significant percentage of MSM had anal HPV infection of any genotypes, with a large portion being HR‐HPV positive. The increasing prevalence of anal HR‐HPV among MSM in Africa highlights the urgent need for increased HPV screening and prevention measures targeted at this population, particularly HIV‐positive MSM (Table 1). HPV vaccination programs are highly effective in reducing the burden of HPV and associated diseases in both men and women. The vaccine offers long‐lasting protection against HPV infections that are most commonly associated with cancer. Although the vaccine is primarily known for preventing cervical cancer in women, it can also prevent HPV‐related cancers in men, such as anal, penile, and oropharyngeal cancers. Moreover, vaccinating men can lead to herd immunity, which can protect women from HPV‐related diseases. Therefore, it is essential to prioritize the HPV vaccine for MSM who engage in anal sex to prevent HPV‐related cancers and reduce the overall burden of HPV in Africa. However, the low uptake of the HPV vaccine in Africa, especially among high‐risk individuals, is concerning despite the vaccine's effectiveness in preventing HPV‐related diseases. Only 14 of the 54 African nations have included the HPV vaccine in their national immunization programs for girls as of 2021, and no countries in western and central Africa have included widespread HPV vaccination in their national immunization programs. Furthermore, currently, no countries in Africa offer HPV vaccination to men. This means that individuals engaging in anal sex, who are at a higher risk of developing anal cancer, are not receiving the protection they need, despite the high prevalence of HPV infection among MSM. This underscores the urgent need to prioritize the inclusion of the HPV vaccine in national immunization programs in Africa, and to ensure equitable access to the vaccine for all persons, including MSM. To improve access to healthcare services and HPV vaccination for MSM in Africa, it is crucial to address both the structural and social barriers that hinder their access to these services. Some of the barriers that HPV‐infected MSM face include a lack of information, general vaccine hesitancy, a lack of advice from healthcare professionals, expense and logistics, and the perception that HPV vaccination may encourage promiscuity. Furthermore, discrimination and the criminalization of same‐sex behavior can further prevent MSM from accessing healthcare programs. A comprehensive approach is necessary to overcome these barriers and improve access to healthcare services and HPV vaccination for MSM in Africa. This includes community‐based interventions, and healthcare professional training to increase awareness about HPV, the benefits of vaccination, and to reduce vaccine hesitancy among MSM. Healthcare professionals should also receive training to provide culturally competent care to meet the unique healthcare needs of MSM in a non‐judgmental manner. Policy changes are also necessary to eliminate discrimination and criminalization of same‐sex behavior and enable MSM to access healthcare services without fear of stigma or persecution. Moreover, to increase vaccine coverage in Africa, the HPV vaccine should be made affordable and accessible to all individuals, regardless of their socioeconomic status. This can be achieved by implementing community‐based vaccination programs, mobile clinics, and school‐ based vaccination programs. Overall, these interventions can help to improve vaccination rates and increase access to healthcare services