Human Papillomavirus Vaccination Initiation Among Sexual Orientation Identity and Racial/Ethnic Subgroups of Black and White US Women and Girls: An Intersectional Analysis

Introduction: Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. Methods: Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N=2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. Results: The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR]=0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR=0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR=0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR=0.19; 95% CI: 0.06-0.56), white lesbians (OR=0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR=0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR=0.21; 95% CI: 0.07-0.67). Conclusions: Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.