Abstract
BackgroundDespite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middle-income countries, stigma remains an issue. Addressing HPV and cervical cancer stigma could significantly improve health outcomes for these conditions. The objective of this study was to identify the manifestations of stigma and their potential impacts on health-seeking behavior.MethodsTwenty-six in-depth interviews were conducted with women living with HIV, HIV-negative women, community health volunteers, and health care providers in Kisumu, Kenya in 2019. The interviews were designed to draw out existing attitudes or experiences related to stigma within the community. We conducted a thematic analysis of the interviews to identify internalized, anticipated, and discriminatory attitudes.ResultsWithin internalized attitudes, a prominent observed theme was a fear of death associated with a positive HPV test. This stemmed from a lack of understanding of differences between HPV and cervical cancer and posed a significant barrier for women deciding to seek screening or to continue with treatment. Discriminatory attitudes of community members, including assumptions of promiscuity, infidelity, or HIV status, were perceived to prevent women from accessing screening and treatment opportunities. The interviews also exhibited a limited awareness of HPV in this region, which may have contributed to a lack of enacted stigma towards people living with HPV or cervical cancer.ConclusionStigma has the potential to lead to decreased screening and treatment uptake through its drivers. This includes a decreased perception of personal risk due to a lack of knowledge, which results in increased HPV-risk behaviors. Future research must focus on creating and integrating stigma-reducing interventions, primarily to encourage women to seek out primary and secondary preventative measures.
Highlights
Despite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middleincome countries, stigma remains an issue
Similar to health care providers, community health volunteers (CHVs) were interviewed on broad categories such as the role of CHVs and CHV training, working with women living with HIV, experiences and comfort with HPV and cervical cancer care, and challenges associated with an HIV, HPV, or cervical cancer diagnosis
The participants consisted of 15 women living with HIV, 5 HIV-negative women, 3 community health volunteers, and 3 health care providers
Summary
Despite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middleincome countries, stigma remains an issue. Addressing HPV and cervical cancer stigma could significantly improve health outcomes for these conditions. High-risk HPV types contribute to 80% of cervical cancer cases and can be prevented through the use of HPV vaccination and cervical. Screening and vaccination for highrisk HPV are effective prevention strategies for cervical cancer. Vaccination can prevent up to 80% of cervical cancer cases, and is starting to become more widely available to adolescent girls in LMICs [4]. With the availability of HPV vaccines and cost-effective screening technologies, the WHO in August 2020 called to action a strategic plan for eliminating cervical cancer [6]. While many high-income countries (HICs) are on target to achieve elimination in the fifty years, vast disparities in screening, treatment, and access to vaccinations may make this ambitious goal impossible to achieve in LMICs
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