Men-who-have-sex-with-men (MSM), women, and transgenders who are people living with HIV (PLWH) are faced with the health disparity of high anal cancer/dysplasia rates. Despite the increased risk and incidence, personal barriers related perception, stigma, access to care, fear, and anxiety of anal disease result in a health disparity gap. It is known the human papillomavirus (HPV) is the causative agent for anal cancer/dysplasia but many PLWH are not vaccinated and there is limited data on its efficacy and effectiveness in PLWH. The health disparity is further compounded by the racial/cultural diversity of PLWH in Hawaii. This project seeks to address this health disparity gap that is experienced by Hawaii’s PLWH by understanding uptake barriers, improving their understanding of possible HPV vaccination benefits, and to determine the vaccine’s efficacy and effectiveness in this unique population. We propose to determine uptake following healthcare provider promotion and determine clinical outcomes in Hawaii’s PLWH. Our central hypotheses are that Hawaii’s PLWH experience a spectrum of barriers that impact HPV vaccination uptake but HPV vaccine promotion by a healthcare provider can increase awareness and increase uptake. Further, measurement of HPV antibody levels will be correlated with clinical outcomes. The significance is to generate critical knowledge which will improve vaccination rates in PLWH in Hawaii and thus reduce the anal cancer/dysplasia health disparity observed in this population which may contribute to the increased anal cancer/dysplasia rates and gain a better understanding of the immune response from the vaccine. The objective is to gain a better understanding of HPV uptake barriers, which is essential to promotion and increasing knowledge and awareness. We propose: 1) To identify personal barriers faced by Hawaii’s PLWH that impact HPV vaccination uptake and 2) To measure clinical outcomes of the HPV vaccine in Hawaii’s PLWH.