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Table 2 Additional verbatim quotations concerning perceptions about HPV vaccination and their implications for cervical cancer prevention

From: Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: a qualitative study

Theme Quotation Source
Perceptions related to efficacy of HPV vaccine
  Many children here used to die from the 6 killer diseases before immunizations began; but the children are now healthy… Around the year 1989, a family here lost four of its members to measles and we all saw it. Who do you think can stop their child from any vaccination after that incident? FGD of parents at School 5
  We have learnt from experience that vaccinations work; especially against polio and measles. We no longer see many cases of those diseases in villages. So we are willing to bring our daughters in future. We want them to be healthy FGD of parents at School 2
  We did not get a chance of being vaccinated, but now that the chance is here for our daughters, let us embrace it; after all we have seen many of our relatives and friends dying of cervical cancer… We all know of people who have died of cervical cancer in our villages FGD of parents at School 1
  My mother died of cervical cancer; I wouldn’t want to see more deaths due to the same disease FGD of parents at School 3
  Many deaths of women due to cervical cancer have occurred in the communities. This works as a live example to the community members that cervical cancer really kills. It has motivated parents to accept that their children be vaccinated to prevent such deaths in future KII with a health worker at B HC II
  I was well taught by my teachers and the health workers who came to our school that the HPV vaccine would protect me from cervical cancer, which can lead to failure to produce children… With HPV vaccination, we shall have healthy lives in future and be able to give birth to children… Parents encouraged us to be strong and get the injection in order for us to be healthy in future FGD of girls at School 4
  We understood HPV vaccination to be for preventing cervical cancer so that we can have healthy reproductive life… Our parents accepted because they wanted us to have healthy life, free of cervical cancer FGD of girls at School 5
  Our girls are lucky to have this chance… They have peace of mind because they are confident that their future is free of the cervical cancer disease… We are happy about the vaccination because it saves our money that would be spent treating cervical cancer in future FGD of parents at School 2
  Some women fail to get screened (for cervical cancer) because of long queues (at Ibanda Hospital). For instance I have been to Ibanda Hospital three consecutive times seeking cervical cancer screening services without success due to the large numbers of women who go there for screening KII, Senior Woman at School 1
  Large numbers of mothers are turning up at Ibanda Hospital for cervical cancer screening… Other than the increased demand for cervical cancer screening services, many mothers are also inquisitive whenever they visit health centers; they are eager to know when their children are due to be vaccinated so that they don’t miss the HPV vaccine… KII, Health worker at B HC II
  We shall allow our future children to go for HPV vaccination because we would want them to live healthy lives like us who have been vaccinated… We would advise our friends to go for HPV vaccination because it is a good way of ensuring a healthy future of a woman FGD of girls at School 2
  Of course we would encourage the girls to be vaccinated since cancer has no cure KII, Senior Woman at School 6
  We are so much aware that the vaccination cannot prevent other STDs. We know that HPV can be transmitted through sex and that use of condoms during sex may not fully prevent the virus FGD of parents at School 2
  The nurses told us to avoid sex because that is how the disease is spread from men. They also advised us to avoid sharing knickers with our friends because the disease could also be spread that way FGD of girls at School 2
  The risks to young girls who have sexual intercourse (with men or boys) are largely the same for all girls… They may get HIV and other sexually transmitted diseases such as gonorrhoea, and now HPV… They usually get pregnant FGD of parents at School 4
  Since these girls were sensitized and educated about the different ways of transmission of HPV, some have changed their behaviour… They are showing less sexual activity because they fear contracting HPV FGD of parents at School 3
  Some girls think that HPV vaccination can protect them from getting pregnant and that is why they go around having sex with men… The girls say that since they received the HPV vaccine, they cannot get pregnant when they sleep with men FGD of girls at School 4
  Other parents believed that this vaccine would reduce the severity of cervical cancer in case one goes ahead to suffer from it even after the vaccination… That cervical cancer would not weaken the girls who have taken the HPV vaccine… FGD of parents at School 3
  No fears have been recently reported about vaccines. In fact, people have been actively involved in immunizing their children against diseases like polio, measles, and hepatitis KII, Senior Woman at School 1
  Some girls complained that their arms got swollen because of the HPV injections but this did not take long. We thought it was just like other injections where the pain would later disappear FGD of parents at School 4
  The girls told us on the day of vaccination that they were feeling some pain in the arms that had been injected but a few days later, they told us that they were fine FGD of parents at School 2
  I first feared taking the injection because I thought my arm would swell and I end up not doing any work or going to school… I thought I would bleed very much after the injection but there was no bleeding… At the first injection, I was worried but for the second one, I was confident and not fearing anything FGD of girls at School 5
  I am not aware of any fears in the community about vaccines in general; no complaints and no rumours about HPV vaccine… KII with Senior Woman at School 9
  Other than the initial rumor of possible sterilization effect of the HPV vaccine, no fears, rumors or serious complaints about HPV have so far been reported both at school and in the community… KII with Senior Woman at School 8
  Some parents still hold old beliefs that vaccinations make children sick. At first, they did not allow their children to get the HPV vaccine; but when the HPV vaccine was explained to them they understood and cooperated FGD of parents at School 4
  People at first feared the HPV vaccination… In early 1990s children were immunized against Polio in Ibanda. About 3 months later, children started dying of fever and high temperatures. Parents here thought that maybe the vaccine was deliberately administered to their children to kill them. Consequently when the HPV vaccine was introduced, parents were suspicious that the vaccine could be meant to harm their children. Besides that concern, there was no other negative perception of the HPV vaccine KII, Senior Woman at School 6
  Nothing is going to stop the vaccination. But maybe with time it will depend on the health of those who have been vaccinated. About 10 years ago, many children died here shortly after being vaccinated against Polio. Only such a scenario would stop the HPV vaccination if it happened among the HPV vaccinated girls KII, Senior Woman at School 9
  They said it kills a woman’s eggs and she does not produce children… Some people got scared after being told in the villages that people who get vaccinated against HPV will not produce children in future… We heard that those who are vaccinated will in future die while delivering children and that worried us… Many of us were worried; they had many disturbing questions in their minds… Some believed that the vaccine was meant to reduce fertility of women in future by destroying their ovaries… That it might be aimed at preventing birth to many kids; a means of reducing the population…These were the rumours spreading in the villages… FGD of parents at School 4
  We heard that the injection kills our eggs so that we don’t produce children in future;…I got worried because I was told I would produce only twins after taking that injection… With the HPV vaccination, we can have safe births in future. The vaccine strengthens the uterus and keeps it safe for normal pregnancy and child birth FGD of girls at School 2
  Some people wondered why it was young girls of a specific age being vaccinated and not mature women… They thought the vaccination was a trick by government to prevent over-population by injecting girls with medicine that would prevent them from giving birth in future… There was rumor that the vaccine damages a girl’s ovaries so she can’t produce children in future. But it was later explained and understood that the vaccinations were meant to prevent cervical cancer FGD of parents at School 5
  One woman came and asked me if it was true that the vaccine meant to sterilize their daughters… I educated her about the vaccine and she went back very happy and willing to encourage the young girls to go for HPV vaccination KII, Health Worker at D HC III
  When the HPV vaccine was first introduced, many people here in Kabagoma had a belief that the vaccine was meant to sterilize women… But this perception changed when a woman in this very village died of suspected cervical cancer. During the funeral service, the health worker who used to treat the deceased used the opportunity to explain to the mourners the suffering and death from cervical cancer… From then onwards, all people got converted…they had no more misgivings about the HPV vaccine KII, Senior Woman at School 1
  Two girls missed the vaccination because their parents discouraged them… Their parents told them that if they got the injection they would never produce children in future… Some parents were not willing that their daughters be vaccinated because of the belief that the vaccination causes heavy bleeding during the menstruation… That the vaccine can cause pain in the uterus FGD of girls at School 5
  Parents in Kicuzi Sub-county barred their children from getting the vaccine to the extent of refusing them to go to school until the RDC and CAO intervened… Those parents had heard rumours that the HPV vaccine would sterilize their children or kill them… KII, Health Worker at B HC II
  The effect of fear of pain of injection was witnessed here in this school where three girls from the same family missed to be vaccinated… I followed them up and even threatened their mothers that they would be arrested if they didn’t take the girls to be vaccinated. Since the parents saw no serious problem with the vaccine they later took the girls to the health centre and they got the vaccine Senior Woman at School 1
  Vaccines are poisons to make people get the diseases against which they are vaccinated and ultimately die… We heard that the vaccine would in future cause cervical cancer to those who receive it…. but when the health workers came and explained it well it was understood FGD of parents at School 4
  They said the vaccine would in future cause disease to those who receive it… That the injection contains chemicals that kill a person gradually; but the health workers came and changed this FGD of girls at School 4
  Although many parents were willing to have their daughters vaccinated, few others were not willing (initially) for fear of losing their daughters; they believed that the vaccination could cause death at some point in future FGD of schoolgirls at School 5
  It was said that when the HPV vaccine is given to children, it weakens their intellect so that they do not study beyond primary seven… They remain with capacity to vote for politicians but cannot question whatever the politicians say FGD of parents at School 3
  I think we are not in position to comment about long term effects of the HPV vaccination now because the vaccination has just been done yet the effects could be seen many years in future… We see the girls are living normal lives; may be in future we would have observed something strange and we report it FGD of parents at School 2
  Some religions such as… advise their believers not to take their children for vaccination… Cult members believe that their God protects the children; so they do not see need to vaccinate their children FGD of parents at School 3
  Sometime in the past,… of the Great African Radio in Mbarara led a campaign against vaccination against the ‘Six killer diseases’. That campaign later contributed to the initial reluctance of some parents to allow their children to get the HPV vaccine. But the parents later accepted after being sensitized about the HPV vaccination KII, Senior Woman at School 5
Questions and uncertainties about HPV vaccine
  Vaccination was done only in schools. Why not even in the villages so that those girls who are not in school can also access it? That is what bothers me FGD of parents at School 4
  When the fist vaccination took place in this school, I was studying in Jason Primary School, a Pentecostal private school where the vaccination did not take place. When I later changed to this school …the health workers came to deliver the second vaccine and I took it and the next one. I don’t know whether there is a problem with that… At the time the first injection was given, I was in hospital looking after my sick mother. So I managed to take the last 2 doses but missed the first one. When will I get what I missed? FGD of girls at School 3
  All girls should be vaccinated; both those who are below the age of 9 and those who are above the age of 9. Even girls in lower classes of P3, P2, and P1 should be vaccinated because some girls start school when they are old KII, Senior Woman at School 9
  Since cancer does not have a cure and there is now a way of preventing it, all girls should be vaccinated… Girls of all ages should be vaccinated to protect them from this killer disease KII, Senior Woman at School 8
  The HPV vaccination program should continue but should use the criterion of age and not class since there are some girls of eligible age who are in lower classes. Screening for the HPV vaccination should start from P 1 and not in P 4 or P 5 as is currently the case KII, Health worker at D HC III