Between Silence and Stigma: Stakeholder Perspectives on Sociocultural Resistance to Human Papillomavirus Vaccination in Lebanon.

Background Despite the role of human papillomavirus (HPV) vaccination in preventing cervical cancer, uptake in Lebanon remains minimal. While previous research has primarily focused on public knowledge and attitudes as well as policy and economic evaluations of a national adoption, limited attention has been given to how sociocultural norms, stigma, and silence contribute to resistance. This study addresses this gap by exploring the perspectives of national stakeholders. Methods Twenty-two semi-structured interviews were conducted with government health officials, medical experts, representatives of scientific societies, public health and communication experts, civil society actors, and staff from UN agencies and health financing institutions. Data were thematically analyzed following Braun and Clarke's method and interpreted through the lens of the Culture-Centered Approach (CCA). Results Three interrelated themes emerged: (1) widespread silence and misinformation about HPV, reinforced by gaps in education and media engagement; (2) cultural taboos and gendered moral expectations complicating vaccination acceptability; and (3) fragmented professional discourse and eroding public trust in health actors. These dynamics interact to reinforce sociocultural resistance. Conclusions Resistance to HPV vaccination in Lebanon is rooted not only in misinformation and limited awareness but also in silence, stigma, fragmented professional discourse, and public mistrust. Addressing these barriers requires culturally resonant strategies guided by the CCA, engaging trusted social actors, and fostering inclusive dialogue to build cultural acceptance and public trust.