Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA.
Department of Obstetrics and Gynecology, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA.
BMC Womens Health. 2022 Feb 11;22(1):39. doi: 10.1186/s12905-022-01619-y.
Despite 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.
Twenty-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.
Within 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.
Stigma 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.
尽管在中低收入国家，人乳头瘤病毒（HPV）和宫颈癌的患病率很高，但污名仍然是一个问题。解决 HPV 和宫颈癌污名问题可以显著改善这些疾病的健康结果。本研究的目的是确定污名的表现及其对寻求健康行为的潜在影响。
2019 年，在肯尼亚基苏木，对 26 名感染艾滋病毒的妇女、未感染艾滋病毒的妇女、社区卫生志愿者和卫生保健提供者进行了 26 次深入访谈。这些访谈旨在引出社区内现有的与污名相关的态度或经验。我们对访谈进行了主题分析，以确定内化、预期和歧视性态度。
在内化的态度中，一个突出的观察主题是对 HPV 检测呈阳性相关的死亡恐惧。这源于对 HPV 和宫颈癌之间差异的缺乏理解，这对妇女决定进行筛查或继续治疗构成了重大障碍。社区成员的歧视性态度，包括对滥交、不忠或 HIV 状况的假设，被认为阻止了妇女获得筛查和治疗机会。访谈还显示出该地区对 HPV 的认识有限，这可能导致对 HPV 或宫颈癌患者的污名化程度降低。
污名通过其驱动因素有可能导致筛查和治疗参与率下降。这包括由于缺乏知识而导致个人风险感知降低，从而导致 HPV 风险行为增加。未来的研究必须专注于创建和整合减少污名的干预措施，主要是鼓励妇女寻求初级和二级预防措施。
