"Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Papillomavirus Infections*/diagnosis ; Papillomavirus Infections*/prevention & control ; Uterine Cervical Dysplasia*/diagnosis ; Uterine Cervical Dysplasia*/prevention & control ; Uterine Cervical Neoplasms*/diagnosis ; Uterine Cervical Neoplasms*/prevention & control; Female ; Humans ; Male ; Early Detection of Cancer/psychology ; Focus Groups ; Mass Screening ; Papillomaviridae ; Social Stigma

Background: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program.
Methods: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis.
Results: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism.
Conclusions: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
(© 2023. The Author(s).)

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R01 CA190366 United States CA NCI NIH HHS

Investigator: I Carhuaza; LE Carrillo Jara; M Del Carmen Caruhapoma; M Del Carpio-Morgan; H Daza Grandez; M Figueredo Escudero; EY Garcia Satalay; SD Gilman; K Gonzales Díaz; J Jerónimo; A Jorges; A Kohler-Smith; M Kosek; G Ladrón de Guevarra; D Lenin de Cuadro; R Lopez Liñán; A Matos Orbegozo; J Marín; G Meza; HE Noble; VA Palacios; EJ Ríos López; P Rivas; K Román; AF Rositch; C Santos-Ortiz; HF Silva Delgado; S Soto; N Tangoa; G Vásquez Del Aguila; K Zevallos
Keywords: Cervical cancer; HPV; Screening; Stigma

Date Created: 20231202 Date Completed: 20231227 Latest Revision: 20240130

20240130

PMC10693157

10.1186/s12889-023-17324-w

38042779