Objective: Human papilloma virus (HPV) vaccination is recommended for all men who have sex with men (MSM) in the USA until the age of 26 years. Despite this recommendation, vaccine uptake remains low. The purpose of this study was to (1) describe salient beliefs related to HPV vaccination among young MSM; (2) determine factors that underlie these beliefs; and (3) describe a model for HPV vaccine decision-making. Design: Qualitative descriptive study. Setting: Central Florida, USA. Methods: Semi-structured interviews (N = 22). Results: The majority of respondents had heard of the HPV vaccine, but generally perceived HPV as a women's health issue. Salient behavioural beliefs about HPV vaccination described physical (such as lowering risk and promoting overall health) and psychological benefits (such as protecting sex partners and providing peace of mind). There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and side effects. Normative influences on decision-making were minimal. Availability, cost and convenience were among the most salient external control factors discussed. Issues surrounding disclosure of sexual orientation, as well as the competence and sensitivity of healthcare providers in dealing with issues of sexuality, were key factors in HPV-related beliefs. Conclusion: Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination.