Abstract
BackgroundHPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico’s early cervical cancer detection program (ECDP). Research on Mexican women’s perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants.MethodsWe conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women’s understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender.ResultsWomen’s confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men’s sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes’ desire for sex as natural but understood men’s negative practices of masculinity, like infidelity, as the causes of women’s HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission.ConclusionsThese results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women’s negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health education and communication.
Highlights
These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of Human papillomavirus (HPV), even among those receiving HPV testing
Our findings reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to lowincome and indigenous-language speaking patients, exacerbate women’s negative emotions surrounding HPV testing
Cervical cancer is one of the main causes of morbidity and mortality among Mexican women, especially low-income women, despite the presence of a national early cervical cancer detection program (ECDP) since the 1970s. [1,2,3,4] In 2008, this program switched from cytology to HPV testing as the primary cervical cancer screening tool.[5,6]
Summary
Cervical cancer is one of the main causes of morbidity and mortality among Mexican women, especially low-income women, despite the presence of a national early cervical cancer detection program (ECDP) since the 1970s. [1,2,3,4] In 2008, this program switched from cytology to HPV testing as the primary cervical cancer screening tool.[5,6] This screening strategy is promising since HPV testing is more sensitive than cervical cytology for detecting high-degree lesions, is more cost-effective than cytology, and is more feasible than cytology in developing countries that face economic and organizational barriers to comprehensive cytology-based screening programs.[1,7,8,9,10,11,12,13,14]Despite the benefits that HPV testing offers as a primary ECDP screening tool, the concept of cervical cancer and screening as virus-related have been found to cause some negative psychosocial effects. Women being tested for or diagnosed with HPV may experience anguish, anxiety, confusion, fear or stigma.[15,16,17,18,19] These experiences might deter women from undergoing HPV testing and cervical cancer screening.[20,21] Such perceptions and experiences regarding HPV and other sexually-transmitted infections (STIs) are profoundly shaped by local culture, especially norms and beliefs regarding sexuality and gender.[17,22] In Mexico, STIs are often stigmatized, posing a risk of emotional suffering that might outweigh their biological risk.[23] Popular cultural understandings of STIs are powerfully linked to gender norms, including nationwide critique of “macho” masculinities characterized by infidelity,[24,25] and local patterns of male work migration such as the largescale male migration that occurs in Michoacán.[26]. We explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants
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