French MSM held mixed perceptions of targeted sexual healthcare policies using HPV vaccination as an example, with some supporting such policies for epidemiological reasons while others felt they stigmatised MSM, and barriers including uncertainty about sexual orientation and difficulty discussing sexuality with doctors were identified.
Key Findings
Results
Some MSM supported targeted sexual healthcare policy because they recognised the epidemiological rationale for distinguishing MSM as a high-risk group.
Participants who supported targeted policy acknowledged the specific epidemiological factors that place MSM at higher risk for HPV
These respondents also expressed a desire for healthcare workers to adopt a non-judgmental attitude toward MSM
Support was linked to recognition that MSM sexual practices differ from those of the general population in ways relevant to HPV transmission
Data collected via semi-structured qualitative interviews in 2022 as part of the French mixed-methods study Vaccigay
Results
Other MSM opposed targeted sexual healthcare policy because they felt it stigmatised MSM and advocated for equal sexual healthcare for everyone regardless of sexual orientation.
Opponents of targeted policy perceived the singling out of MSM as a form of stigmatisation
These respondents advocated for universal rather than group-specific sexual healthcare approaches
The tension between targeted and universal approaches reflects broader debates about equity versus equality in public health
Interviews were transcribed verbatim and thematically analysed using NVivo software
Results
Uncertainty about one's own sexual orientation was identified as a barrier to accessing targeted sexual healthcare.
MSM who were uncertain about their sexual orientation found it difficult to access care framed specifically for MSM
This barrier is particularly relevant given that targeted HPV vaccination policy in France explicitly identifies MSM as the eligible group
This finding suggests that identity-based targeting may exclude individuals who engage in same-sex practices but do not identify as MSM
Results
Difficulty discussing sexuality with doctors was identified as a barrier to accessing targeted sexual healthcare among MSM.
Respondents reported challenges in openly discussing their sexual practices and orientation with healthcare providers
This barrier limits the effectiveness of MSM-targeted recommendations even when MSM are aware of them
The finding underscores the importance of non-judgmental clinical communication in delivering sexual healthcare to sexual minorities
Background
HPV vaccination in France is recommended up to age 19 for all persons and up to age 26 specifically for MSM, representing a targeted sexual healthcare policy.
The general population recommendation covers persons of both sexes up to 19 years of age
The upper age limit is extended to 26 years for MSM, who are classified as a high-risk group
This age extension for MSM constitutes a targeted policy because it accounts for the specificities of MSM sexual practices
Participants were selected by age and HPV vaccination status for the qualitative study conducted in 2022
Conclusions
The authors recommend extending HPV vaccination to all adults up to age 26 regardless of sexual orientation, alongside improving healthcare worker training and increasing sexual health centres serving sexual and gender minorities.
Recommendation to extend HPV vaccination to all adults up to 26 years irrespective of sexual orientation was proposed to reduce stigma and improve coverage
Improved training of healthcare workers on the specific needs of sexual and gender minorities was recommended
Increasing the number of sexual health centres serving these populations was also recommended
These recommendations were drawn from the qualitative findings on barriers and perceptions identified among MSM respondents
What This Means
This research explores how gay and bisexual men (referred to as men who have sex with men, or MSM) in France perceive a public health policy that specifically targets them for HPV vaccination up to age 26, compared to the general population cut-off of age 19. The study, part of a larger French project called Vaccigay, used in-depth interviews with MSM selected based on their age and vaccination status, conducted in 2022. Responses were analyzed using qualitative research methods to identify common themes in how participants understood and felt about being singled out for this healthcare benefit.
The research found that MSM were divided in their views. Some appreciated the targeted approach, understanding that their sexual practices put them at higher risk for HPV and wanting doctors to treat them without judgment. Others felt that being specifically named as a high-risk group was stigmatizing and preferred that sexual healthcare be offered equally to everyone, regardless of sexual orientation. Beyond opinions on the policy itself, the study found that two practical barriers prevented MSM from accessing this targeted care: some men were uncertain about how they identified sexually and therefore did not see themselves as eligible, and many found it hard to talk openly about their sexuality with their doctors.
This research suggests that identity-based health policies, while grounded in valid epidemiological evidence, can unintentionally exclude people who engage in same-sex behavior but don't identify as MSM, and may reinforce feelings of stigma among those they are designed to help. The authors suggest that broadening HPV vaccination eligibility to all adults up to age 26 — regardless of sexual orientation — could reduce stigma while maintaining public health benefits. They also call for better training of healthcare providers to discuss sexuality in a non-judgmental way and for more accessible sexual health services for LGBTQ+ communities.
Oliveri C, Mora M, Annequin M, Brosset E, Fressard L, Cogordan C, et al.. (2025). Perceptions of targeted sexual healthcare among French MSM based on HPV vaccination policy in France.. Scientific reports. https://doi.org/10.1038/s41598-025-20412-z