A 40‑year‑old man walked into a South African clinic with a persistent lump in his throat. He did not smoke, drank only occasionally and had no family history of cancer. The diagnosis that followed – an HPV‑related throat cancer – is becoming increasingly common, yet most men are never warned about the virus that caused it.
Human papillomavirus (HPV) is the world’s most prevalent sexually transmitted infection. While it is widely recognised as the cause of 95 % of cervical cancer cases, the same virus also drives cancers of the penis, anus and oropharynx in men. In South Africa, the national immunisation programme offers the HPV vaccine to girls aged nine to fourteen, but boys are excluded. As a result, men remain largely unprotected and, because there is no routine HPV‑related cancer screening for males in the public sector, many diagnoses are made only after the disease has progressed.
Globally, about one in three men carries at least one genital HPV type, and one in five harbours a high‑risk strain such as HPV‑16, which is responsible for the majority of HPV‑driven cancers in both sexes. Most infections clear spontaneously within two years, but persistent infection can lead to malignancies that are harder to treat when detected late. In high‑income countries, HPV‑positive throat cancers in men now outnumber cervical cancer cases in women, a trend that is mirrored in South Africa’s rising cancer statistics.
Transmission occurs through vaginal, oral and anal sex as well as skin‑to‑skin contact. Condoms reduce but do not eliminate risk because the virus can infect areas not covered by a barrier. Men also face non‑cancerous consequences: studies link HPV to reduced sperm quality and an increased risk of prostate cancer, a disease projected to rise by almost 65 % worldwide between 2020 and 2040.
The exclusion of boys from the public vaccination programme is justified by the World Health Organization’s recommendation to prioritise girls aged 9‑14 where resources are limited. South Africa’s school‑based campaign assumes that vaccinating girls will generate herd immunity that indirectly protects boys. However, coverage is incomplete, vaccine‑induced immunity wanes over time and viral variants continue to emerge. Relying solely on indirect protection leaves a substantial gap in men’s health security and raises concerns about gender equity.
Private vaccination is available but costly, ranging from R1 102 to R2 365 per dose, and is rarely covered by medical aid schemes. Economic analyses from other settings, including China, demonstrate that vaccinating adolescent boys is not only effective but also cost‑effective, preventing hundreds of thousands of cancer cases over a generation. South Africa’s commitment to universal health care under the National Health Insurance Act strengthens the case for expanding public funding to include boys.
Several high‑income nations have already adopted gender‑neutral HPV vaccination policies, and the United Nations General Assembly now endorses the inclusion of boys in national programmes. In Africa, Cameroon and Mauritius have introduced male vaccination, and Eswatini plans to follow later this year. Evidence shows that vaccinating both sexes can achieve the same level of population immunity in eight years that would otherwise take two decades with a girls‑only strategy.
The situation calls for urgent policy action. Expanding the public HPV vaccine to boys, increasing public awareness of men’s HPV risks and integrating routine screening where feasible would close a critical health gap. Ignoring male susceptibility not only perpetuates preventable disease but also undermines broader goals of equitable health protection.
The authors – public‑health researchers Damian Naidoo and Kaymarlin Govender, and psychiatrist Joanne E. Mantell – argue that South Africa’s progress on HPV prevention must now include men, ensuring that the promise of universal health care truly covers all citizens.
