Impact of human papilloma virus vaccination on adolescent knowledge, perception of sexual risk and need for safer sexual behaviors in Bali, Indonesia

Abstract Aim: To determine the impact of human papilloma virus (HPV) vaccination on knowledge, perception of sexual risk and need for continued safe sexual behavior among Indonesian girls. Methods: A comparative cross-sectional study was carried on in Denpasar, the capital city of Bali, Indonesia, during September 2015–February 2016. A total of 828 adolescent girls (12–16 years) were recruited to assess their knowledge on HPV/HPV vaccine, perception of sexual risks and need for continued safe sexual behavior. Results: A total of 419 girls (50.7%) had received HPV vaccination prior to the study, 76.4% of whom (320/419) had sufficient knowledge about HPV. HPV vaccination was a strong and independent predictor of higher HPV/HPV vaccine knowledge (adjusted OR [AOR], 9.358; 95%CI: 6.816–12.849, P < 0.001). HPV vaccination (AOR, 0.107; 95%CI: 0.074–0.155, P < 0.001) and higher knowledge level (AOR, 0.667; 95%CI: 0.464–0.958, P = 0.028)were associatedwith lower perceived HPVrisk. Despite the low risk perception,most of the vaccinated girls (408/419, 97.4%) continued to perceive higher need for safe sexual behaviors. On multivariate analysis, higher knowledge was the independent predictor for higher perceived need for safe sexual behaviors (AOR, 4.260; 95%CI: 2.016–9.001, P < 0.001). Conclusion: The HPV vaccinationwas associated with higher knowledge and appropriately lower perception of HPVrisk. Despite the vaccination, most of the adolescents continued to perceive a need for safer sexual behavior. All adolescent girls should receive HPV vaccination in order to reduce cervical cancer burden in the future. Key words: adolescent, human papilloma virus vaccine, Indonesia, need perception, sexual risk perception.