HPV Misunderstood, Feared in One Border Community


Hispanic men and women living on the United States-Mexico border have little understanding about the human papillomavirus and its role in the etiology of cervical cancer, according to a small prospective study.

Not only were there very low levels of knowledge among these residents, but their misconceptions and confusion continued even after they were given some basic information about HPV and cervical cancer, Maria Fernandez, Ph.D., said in Carefree, Ariz., during a press conference sponsored by the American Association for Cancer Research. For example, participants tended to compare HPV with HIV and other sexually transmitted infections, and were confused or unaware that men could have HPV and transmit it.

She reported on 30 Hispanic women and 11 Hispanic men without a diagnosis of HPV who lived in Rio Grande Valley colonias (unincorporated border settlements) and participated in focus groups in Brownsville, Tex. The mean age was 41 years among the women (range, 20–74 years) and 39 years among the men (range, 19–76 years). The average annual income for a family of four in these semirural neighborhoods was $13,000. About 60% of participants had not completed grade school.

Analysis of the Spanish-language focus group transcripts revealed that attitudes and concerns about HPV differed by gender, said Dr. Fernandez of the division of health promotion and behavioral sciences at the University of Texas in Houston. Women in particular viewed the disease with fatalism, interpreting a diagnosis of HPV as a diagnosis of cancer. They expressed their fears of cancer and their belief that, once diagnosed, it is “essentially a death sentence.” The women said they would be reluctant to disclose their HPV status to their partners because they believed they would be accused of infidelity.

Men initially expressed anger at the possibility of an HPV diagnosis, attributing it to infidelity, Dr. Fernandez said. After a brief explanation about the ambiguity of HPV transmission, they ascribed their initial reaction to cultural ideals of machismo. Women also said that machismo would lead to reactions of anger and accusations of infidelity.

Dr. Fernandez acknowledged that the border communities and colonias face unique challenges, and that the findings of this small, qualitative study should not be generalized to other Hispanics or Mexican Americans.

“On the other hand, it raises some interesting questions about what we've heard in many other studies about cultural norms, such as things like machismo and the way we've traditionally interpreted this concept,” she said. “As we saw in these focus groups, there's sort of an initial reaction, but then people talked about standing by their partner.”

Clues about these cultural norms and beliefs are essential to the design and implementation of successful and badly needed interventions for HPV and cervical cancer prevention.

“You have to be very cautious in terms of generalizing these findings, but many of the populations that are suffering increased incidence of HPV and cervical cancer and increased mortality are in this area,” Dr. Fernandez said.

The study was funded by the National Institutes of Health. The authors reported no conflicts of interest.

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