Modelling the Effects of Smoking Behavior on Male-to-Male HPV Transmission and Anal Cancer Progression

Human Papillomavirus (HPV) infection among men who have sex with men (MSM) has become a significant public health concern, particularly in countries where male vaccination is unavailable. Given the high susceptibility of MSM to HPV and anal cancer, and the unavailability of HPV vaccination for males in low- and middle-income countries (LMICs), there is a need to identify alternative interventions for reducing disease transmission and burden in this population. The novel mathematical model presented in this article couples smoking behavior dynamics with HPV transmission and anal cancer progression among MSM. Smoking reduction is introduced as an intervention to assess its effects on disease transmission and burden. The basic reproduction number ( R ₀ ) is derived using the next-generation matrix method, and a global sensitivity analysis is performed using partial rank correlation coefficients (PRCC) to identify the influence of model parameters on R ₀ . Further, the theoretical analysis of the model reveals a backward bifurcation, implying that R ₀ < 1 is necessary but not sufficient to eradicate the disease. The study finds that smoking reduction among MSM reduces HPV infection and anal cancer burden relative to baseline projections without intervention. The joint effect of smoking reduction and vaccination shows that the critical vaccination coverage needed to achieve R ₀ < 1 decreases as the level of smoking reduction increases. A similar outcome is observed for contact reduction. These findings highlight the importance of concurrent interventions, which can significantly curtail the spread of HPV and reduce disease burden in both the high-risk group and the general population.