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HPV: Overcoming stigma on the road to health

Becky Silva would rather not talk about the virus that nearly claimed her life. She keeps changing the subject – admiring the weather outside the window of her Westside apartment, talking about the birthday party she plans to throw for her six-year-old daughter next weekend.

“It was really scary,” she admits of her illness, “but it’s over now.”

It’s over for Becky, at least. But millions of women, especially Latina women, continue to discover that the human papilloma virus (HPV) they didn’t know they had has led to something worse.

HPV is a strain of nearly 100 viruses that cause infections of the skin and mucus membranes. Although most types of HPV exhibit no symptoms, some of the more virulent types cause rashes and warts and can become cancerous. Nearly half of the known types of HPV are transmitted through sexual contact and can lead to genital warts, although most HPV infections are short-lived and have little long-term effects. Nearly 70 percent of these infections are resolved within a year. But, when the infection goes undetected and persists, it can lead to pre-cancerous lesions of the cervix, which can become cervical cancer. These progressions to invasive cancer can usually be stopped with prevention strategies. Cervical screening, via traditional Pap tests, can catch abnormal cells that may develop into cancer. While simple strategies can detect HPV and prevent it from becoming something more serious, many women don’t bother. And Latinas, according to some studies, are leading that pack, thanks in part to a stigma that links it, in some cultures, to promiscuity.

“Well, HPV was a sex disease,” Becky says, letting out a big sigh, “and in my house, you didn’t talk about certain things, especially sex. Talking about sex was bad; it was wrong; you were a dirty person if anyone even thought you were thinking about sex. It was behind closed doors, and that was just the way everyone I knew lived their life. And if you got a sickness that was related to having sex, well, forget it. Your life was over.”

Becky says that no one in her family went to the doctor, because her grandmother was a healer who disdained modern medicine and favored homemade remedies. “So, I never got a Pap smear,” Becky says with some embarrassment. “I mean, it was just me and my husband, and everyone told me growing up that Pap smears were for easy girls who slept around.”

During a routine checkup following Becky’s first pregnancy, it was discovered that she was positive for HPV. She told her husband, who took the news of her illness to mean that she had been unfaithful to him. “He took off,” she says, six years later. “And my mother didn’t believe me when I said that the doctor told me I could have gotten this from my husband. She threw me out. I was alone, with a new baby, and the doctor was saying that now I could get cervical cancer.”

Cervical cancer incidence and death rates, per 100,000, by race and ethnicity in the United States

According to recent studies done by the California Medical Association (CMA), Latinas are less likely to be screened for HPV than women of other ethnic backgrounds. They are also, according to the CMA, less likely to get a Pap test that would reveal the presence of HPV. Data from the Centers for Disease Control and Prevention for 2007 indicate that for every 100,000 cases of HPV-associated cervical cancer diagnosed in the U.S., 7.5 are white women, 10.2 are black women, and 6.5 are Asian/Pacific Islander women. But, the greatest number diagnosed with cervical cancer are Hispanic women – 11.5 out of every 100,000.

The higher HPV-positive numbers among Latinas is largely related to cultural attitudes about sex among Hispanics, who are less likely to discuss sex and sexuality, and who often (as in the case of Becky’s grandmother) discourage discussion of sex-related illness.

An aversion to Pap smears and other HPV-related testing isn’t just about the stigma of having a “sex disease,” according to psychologist Jane Delgado. “Hispanic women often don’t have a regular source of care,” says Delgado, president and CEO of the National Alliance for Hispanic Health. “If they had an HPV result that was positive, they need treatment and they need follow-up – and it’s important to come back. That’s how you can prevent cervical cancer. That any woman in this country has cervical cancer should be a source of embarrassment to us as a nation.”

The eye of the HPV storm is GARDASIL, the controversial vaccine that protects men and women against strains of the virus. The drug was approved back in June of 2006, for use by girls and women aged 9 to 26; three years later, the Food and Drug Administration (FDA) approved its use by males. (The vaccine had already been approved for men in Mexico by that time.)

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This Article appears on the March 2012 issue of LPM under Health

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