Table 2 Key barriers to HPV and meningococcal vaccination and exemplary quotes

Limited awareness and knowledge

 …about HPV and HPV vaccination

“All I know is it’s [HPV is] a thing that you can get. Like it’s not high on my radar of STDs [sexually transmitted diseases] or anything else.” (John, 40s, White, ≥ college degree)

“I have not had relationships with someone with a uterus and from what I understand, it [HPV] is more of a risk when you have relationships with a person with a uterus.” (Quin, 20s, Hispanic, ≥ college degree)

 …about meningococcal disease and meningococcal vaccination

“Meningitis…when I first heard about it, I was clueless, until I looked it up and saw what it was. … it is the… the one, disease, we’ll use that word, that you do get as a college freshman if you choose to live in the dormitories. It is very common amongst college freshmen.” (Ava, 20s, multi-racial, ≥ college degree)

“In all honesty, I know almost nothing about meningitis.” (Quin, 20s, Hispanic, ≥ college degree)

Reliance on mainstream healthcare providers

“When I was in San Diego, I had a gay doctor because I was in a good community and now I’m out here in the wilderness in the barbaric lands of the Inland Empire and I wouldn’t even know where to find a gay doctor anymore.” (John, 40s, White, ≥ college degree)

“I would like to know from my doctor, how effective the (meningococcal) vaccine is for people in my age group... it would be good for me to have that information.” (Alex, 50s, Asian/Pacific Islander, ≥ college degree)

Stigma and reluctance to disclose sexual orientation

“[I told my doctor] I’m a gay man so if there’s any special risk factors from anything that you can let me know. It freaked him out, he left, he was never available again to meet with me.” (John, 40s, White, college degree)

“I think it is the stigma, I think in the Latino community we do not talk much about issues especially sexual health. So it is, in my family we never talk about anything sexual. All of the sex ed happens at school or on the internet or by friends” (Boots, 20s, Hispanic, ≥ college degree)

Uncertainty about health insurance coverage and vaccine costs

“…the other day I went to be tested for HIV here in San Bernardino and I saw that a person—they didn't want to give her a blood test because she didn't have insurance. Well, I had insurance, but the insurance company didn't want to pay, so that's what comes to mind is access to this [meningococcal] vaccine.” (Xochipili, 20s, Hispanic, ≥ college degree)

“I know people who, they wanted to receive it [HPV vaccine], but the insurance did not cover it. I think they told me it would cost them like six hundred dollars because that's three and each dose was worth about one hundred and eighty or something like that.” (Boots, 30s, Hispanic, ≥ college degree)

Distance and time required to access vaccines

“The clinic that was telling me to get vaccinated did not offer the HPV vaccine. So they were telling me to go to this other place that, where I could get it…even though I would want to get the HPV vaccine, at the time, I just wasn’t able to… I had no reliable means of transportation.” (Wario, 20s, Hispanic, ≥ college degree)

“I have a very demanding job that makes seeing medical professionals difficult.” (Ailesq, 20s, Hispanic, ≥ college degree)