News article
A shot for the future – what happened when the HPV vaccine became gender-neutral?
Each year, around 1,000 women and 550 men in Sweden are diagnosed with a form of cancer caused by HPV. Since 2020, boys have also been offered the HPV vaccine in schools – an important step for both public health and gender equality. However, the conversation about sexuality in connection with vaccination needs to be developed, says Lisa Lindén, Associate Professor in gender and technology, who leads a Forte-funded project studying how the new gender-neutral HPV vaccination is received in schools.
Illustration: Erika Losciale
HPV (human papillomavirus) is the virus behind genital warts and, more rarely, cancer – of the cervix, genitals, and throat. In 2010, HPV vaccination was introduced for girls aged 11–12 in the national immunisation programme, as it had proven effective against cancer when administered before sexual debut. Ten years later, boys of the same age were also included in the programme.
But what changes and challenges has the new gender-neutral policy brought, and how has it affected perceptions of sexuality and sexual health? Lisa Lindén and Josefin Persdotter at Chalmers University of Technology, together with Ylva Odenbring at the University of Gothenburg, have investigated this through observations of vaccinations at two schools and interviews with school nurses, students, parents, and policymakers.
More knowledge and support needed for better outreach
"The vaccine is often referred to as a cancer vaccine, and that’s also how it’s usually discussed in schools. But it actually concerns a sexually transmitted virus. Therefore, we must also be able to talk to children about sex, sexual responsibility, and gender equality in an age-appropriate way. Avoiding the topic—which is a common strategy we observed in our study and in previous research—is not a good solution," says Lisa.
The study shows that children often have questions and thoughts that don’t always surface in large groups or at the moment of vaccination. Now that boys are also included, the range of sexual identities and practices has broadened, and there is often a wide variation in knowledge about sex and physiology among the children.
"To respond to the children’s questions, school staff need more knowledge and support on how to talk about sexuality in a broader context, and perhaps more often in smaller groups. HPV vaccination could ideally be integrated with education on sexuality, consent, and relationships," Lisa adds.
In order to address children's questions and reflections, school staff need increased knowledge and support on how to talk about sexuality from a broader perspective.
Lisa Lindén
Associate Professor in gender and technology at Chalmers University of Technology
In conversations with school nurses, there was initially concern that questions might arise from boys’ guardians, such as: "What do they have to do with cervical cancer?" However, the issue seems to have become normalised over time, and the anticipated vaccine scepticism has not affected coverage. Most guardians are positive about the vaccination programme now including all children and give their consent regardless of the child’s gender.
"Many school nurses also feared that their workload and planning would increase. After all, the number of students to be vaccinated doubled. But it turned out to work better than they had expected, since the structure was already in place," Lisa explains.
Greater understanding of school nurses’ work
The study has also highlighted the invisible work required of school nurses to make it function in practice. It shows that a school nurse uses a whole range of strategies during vaccination, such as calming the child, counting down together, and letting them rest on the examination table afterwards. But this work is rarely documented.
"This work is essential for school nurses to be able to do their jobs—many children are afraid of needles. Yet it often goes unrecognised. There’s a clear need for both policymakers and school leaders to understand that school nurses need time and space for unexpected situations. Policies always need to be adapted to the local context, and in this case, it’s the school nurses who make the policy a reality," Lisa concludes.
Jenny Asp (English translation by Forte)
Human Papillomavirus (HPV)
HPV is a group comprising over 200 different virus types. Some HPV types cause common skin warts, others cause genital warts (condyloma), and a few can cause cancer.
HPV spreads easily through skin or mucous membrane contact and is the most common sexually transmitted infection in Sweden. Most HPV infections are mild and clear up on their own. But sometimes the infection persists, increasing the risk of cancer.
More cancer cases are related to HPV infection in women. This is because HPV infections increase the risk of cervical cancer and cancer of the vulva or vagina. But men can also be affected, for instance, in the throat or anus.
There is an increased risk of HPV-related cancer among men who have sex with men, transgender individuals, and people living with HIV.
Vaccination provides excellent protection against HPV-related cancer if administered before HPV infection occurs (90 percent protection). Today, all children in year five of school are offered the HPV vaccine as part of the national childhood immunisation programme.
Source: The Public Health Agency of Sweden
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