The Human Papillomavirus (HPV) is the most common sexually transmitted disease (STD) in the U.S. It is linked to cervical cancer and cancers of the vagina, penis, anus (anal), throat, tongue, and tonsils. These cancers can take years develop but begin when someone becomes infected with the virus. There is only a routine screening for cervical cancer.
The Science Behind HPV
HPV has a genome made of double stranded DNA. Like other DNA viruses it has the ability to incorporate itself into the genes of its host, in this case humans. Once it is incorporated into the hosts DNA, its genes get replicated whenever the cell replicates. Depending on where the virus incorporates itself into the hosts DNA, it can turn cell growth genes permanently. This results in abnormal cell growth that leads to cancer. When you go to the gynecologist for Pap smear (Pap for Papilloma), this is what the doctors are looking for: abnormal cervical cells.
Every year, an estimated 17,600 women and 9,300 men are diagnosed with cancer resulting from HPV infection. When broken down into communities, statistics show Hispanic women have the highest rates of cervical cancer, but African American women have the highest rate of death as a result of HPV infection since 1975 due to decreased likelihood of early disease detection. AA women also have the highest rates of vaginal cancer as a result of HPV infection. AA men have higher rates of anal cancer when compared to white men and Hispanic men have higher rates of penile cancer than non-Hispanic men.
The good news is that the HPV strains that are most likely to cause cancer are preventable and have been since the advent of the HPV vaccine in 2006. The bad news is that women of color, particularly Black women, are less likely to have their children (or themselves) vaccinated. The advisory committee on immunization practices recommends males age 13-21 and females age 13-26 be vaccinated. The vaccines are administered in 3 doses at timed intervals: 0, 1-2, and 6 months.
Vaccination rates from 2015 indicated that coverage for females age 13-17 was at 60% for the first dose of the vaccines and 39.7% for the third dose as of 2014. African Americans have the lowest series completion rate at 61.6%. Studies have shown that 48% of AA have never heard of the vaccination and those who were aware were female, employed, had some years of college education an annual income of $40,000, a regular doctor, had fewer children and were younger than 41 years of age. Awareness of HPV and the vaccine was also associated with cervical cancer diagnosis (i.e. they or someone they knew had a diagnosis).
Lets Talk About Vaccination
Among AA parents, the most common vaccination barriers were concerns about safety, concerns that the vaccination would encourage promiscuity or pre-marital sex, lack of information, and lack of recommendation by doctor or perceived hesitance of a recommendation by a doctor. Additional barriers included perceived low risk of children acquiring HPV, mistrust in pharmaceutical companies, mistrust of medical providers, religious denomination and frequency of religious service attendance, concern about daughters being too young, and creating a false sense of protection against all HPV strains.
After wading through all of the facts, what it boils down to is that Black women have the highest rate of cervical cancer deaths, yet we are least likely to have our daughters vaccinated. The reasons why people are vaccinating their daughter boils down to either distrust in doctors and pharmaceutical companies or the fear that having our children vaccinated against an STD will somehow encourage them to start having sex or have more sex. Does anyone see the faulty logic in this? This falls into the same line of reasoning that talking to your kids about sex promotes sexual activity.
As a mother, a Black Christian women, and a scientist, I do not understand this logic. Even if your child does wait to have sex until they are married, chances are that their spouse did not. If protecting your child is the goal, denying them a vaccination in the name of purity culture does not serve them well. Perhaps reframing the discussion as that of your preparing a child to be a successful adult might encourage parents and caretakers to reconsider how helpful a vaccination can be in helping the current child avoid contracting a preventable virus from a future sexual partner. This vaccine can prevents cervical cancer. That is nothing short of a miracle that I embraced with all of my identities and encourage others to do the same.
Black communities in the United States have legitimate reasons for not trusting the scientific and medical industries (Tuskegee, Henrietta Lacks, the origins of US gynecology, etc). As a member of both the science and Black communities, I encourage us to consider that we can be both healthily skeptical of practices and intentions within the science industry/community AND recognize the ways that scientific and medical advances can support our health and well-being. How can Black communities build trust with medical and scientific communities? I genuinely want to know because as a Black scientist, I chose this field because I wanted to help my community through my research. I want to break down the walls of communication so that we can be free to live long and healthy/healthier lives.
The biggest take home message for me with these data is that we need to get the word out to the parts of the community that are older, less likely to be college educated and more likely to be skeptical of the medical and scientific community. I think the best way for us to get vaccination rates up is by reaching out to the people in our communities who fit this description. I know that I do my fair share of communicating these things to my friends and family and I can only hope that they are passing these things along. This may also require leading by example. If you are reading this and you aren’t vaccinated and you are 45* and under, GET VACCINATED! If you have a child (of any sex and/or gender) within the recommended vaccination age, GET THEM VACCINATED!
I am challenging the #CiteASista community to share this post among friends and family and begin/continue a conversation about sexual health. Do your own research and share that too. We have to be able to uplift our community so that we can be more informed and healthier. If you have any ideas on how to improve communication between doctors and scientists to our communities, please leave them in the comments.
*Point of emphasis: The vaccine has been recently been cleared for people up to age 45!!!! This is GREAT NEWS.*