“Why the Introduction of Sensitive Vaccines Require Different Approaches in Indigenous Communities. Findings from a HPV Vaccine Attitude Study in Two Australian Aboriginal Communities and Lessons for International Indigenous Communities.”

Background:
This Australian study examined the attitudes of Aboriginal Health Workers (AHWs) toward mass immunisation with the human papillomavirus (HPV) vaccine in remote and urban Aboriginal regions. In Australia HPV vaccine mass immunisation was targeted to females between ages 9 to 26 years.

Objectives:
Its introduction was considered highly sensitive in some cultural groups and raised challenging issues in its administration, and for those who are offered the vaccine. The HPV vaccine is particularly pertinent in Australian Aboriginal communities where there is a higher incidence of cervical cancer incidence and deaths than non-Aboriginal communities. The initial uptake of the third dose was low in some Australian regions.

Methods:
Participants for the Aboriginal cultural group's qualitative focus group discussions were purposively selected according to Aboriginal descendency, gender (female only), and AHW status. The sample is not representative of the wider cultural group in Australia. Recruitment was through Aboriginal health associations and clinics; and the Aboriginal Reference Group that advised the study. AHWs were educated about HPV vaccine prior to the study and disseminated the knowledge to their communities.

Results:
The findings from AHWs demonstrated that the national introduction of sensitive vaccines cannot be generalised to Indigenous populations. Whilst there were similarities in attitudes toward support for the vaccine; adolescent behaviours; concerns about vaccine safety and efficacy there were significant differences in how communities should be educated; age of vaccination; stigma; perceived risk of promiscuity and infrastructure needs.

Conclusions:
By understanding the perspectives and development needs from two Aboriginal communities for culturally appropriate HPV vaccine information, education and resourcing, it enable insights into what is required for optimum and culturally sensitive delivery of the HPV vaccine. Global mass immunisation strategies need to consider specific issues relevant to Indigenous communities for high uptake.