The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) (CDC, 2022c; Holloway, 2019). Most HPV infections are asymptomatic, and 90% of HPV infections resolve themselves spontaneously (CDC, 2023). However, if an HPV infection persists, it might result in pre-cancerous or cancerous lesions (Fabiano et al., 2022). HPV is the proven cause of several clinically significant diseases, such as genital warts, oropharyngeal, head and neck, cervical, vaginal, vulvar, penile, and anal cancers (CDC, 2022b). It can be transmitted through various sexual activities, including vaginal and anal intercourse, and oral sex (CDC, 2022a). Safe-sex behaviors to prevent HPV infection include avoiding multiple sexual partners and using a condom throughout a sexual encounter (CDC, 2022a; Whiting et al., 2019). In addition, every sexually active woman should get the Papanicolaou (Pap) test (Lai & Hsieh, 2020). In recent years, both men and women have been urged to receive the HPV vaccine to prevent infection (Chan & Wong, 2019; Lai & Hsieh, 2020). Many countries have introduced the HPV vaccine to reduce the morbidity rate of HPV (De Sanjose et al., 2019). A recent systematic review and meta-analysis of 60 million people showed that HPV vaccination significantly influenced the incidence rate of HPV-related diseases (Drolet et al., 2019). Vaccination prevented >90% of cancers caused by HPV (CDC, 2022c).

Although HPV vaccines were approved in Taiwan in 2006, at the time only a few cities and counties used the local budget for HPV vaccination programs to provide free vaccines to teenage girls in aboriginal areas and island districts or low-income families (Lai & Hsieh, 2020). It was not until the World Health Organization (WHO) suggested including the HPV vaccine in the national immunization program (WHO, 2017) that the Taiwanese government fully funded HPV vaccines for girls admitted into school at age 13 as part of its HPV vaccination program in 2018 (Chen et al., 2023). However, the policy did not cover boys and would not allow older girls to get subsidized free vaccines (Lai & Hsieh, 2020). HPV vaccines cost about 3000–6000 Taiwan dollars (96–191 United States dollars, USD) per dose, depending on the brand, which is a considerable expense and burden for three shots.

Approximately 4.5% (about 630,000) of all new cancer cases per year worldwide are attributable to HPV (De Martel et al., 2017). In the United States, around 47,199 new cases, including adolescents and young adults, are reported annually (CDC, 2022b). It has been estimated that the lifetime medical cost of diseases attributable to HPV infections is 774 million USD, of which approximately half is accounted for by infections among those aged 15 to 24 years (Chesson et al., 2021). In the United Kingdom, considerable medical resources are used to treat HPV-related diseases, and the burden on hospital resources is a primary public health problem (Fabiano et al., 2022). No large-scale HPV screening reports have been conducted in Taiwan to date. However, a survey of Taiwanese adolescents and young people (ages 20 to 24) noted a high proportion having casual sex (Tseng et al., 2021). Their interaction with peers also tended to center around sexual issues and sexually explicit material such as videos, movies, TV shows, magazines, or photographs, showing images and acts related to sex (Tseng et al., 2021). This showed that the younger generation was more sexually liberal. In 2020, a survey on perceptions and attitudes toward HPV of people aged 19 to 45 in Taiwan showed an inadequate understanding of HPV (Formosa Cancer Foundation, 2020). Thirty-three percent of people had had sex without any emotional attachment to the sexual partner, and 67% did not keep the condom on throughout the sexual encounter. Among this population, people aged 19 to 35, including young people in college, accounted for the highest proportion (Formosa Cancer Foundation, 2020). However, these college students were in their emerging adulthood phase (Arnett, 2000), a period between adolescence and young adulthood in which they explored and developed intimate relationships and their identity as adults. Furthermore, they learned to take on their responsibilities, including, of course, the responsibilities and decisions regarding their sexual health (McMahan & Olmstead, 2021).

Based on the above literature, HPV infection is the most common sexually transmitted disease worldwide, with the potential to lead to various types of cancer. Both men and women are at risk of infection (CDC, 2022a). Furthermore, as young generations have adopted more open attitudes toward sexuality, HPV infection rates have risen (Meites et al., 2019). It is essential therefore to understand whether or not they are effectively adopting protective measures to avoid HPV infection (Nkwonta et al., 2022). However, many studies have focused primarily on investigating the prevention of cervical cancer in women and HPV vaccinations (Chen et al., 2023; Thanasas et al., 2020; Tosun et al., 2022), while there has been relatively limited research dedicated to exploring issues related to HPV perceptions and prevention measures. Consequently, this study explored college students' perceptions of HPV infection and their thoughts on prevention measures.