Overcoming barriers to HPV vaccine acceptance.(human papillomavirus)

The advent of preventive human papillomavirus (HPV) vaccines has created new opportunities for improved health care for women, which will require both patients and physicians to develop new paradigms and strategies to deal with HPV-related diseases. New thinking is needed to take advantage of our ability to prevent these diseases, instead of just treating the sequelae of HPV infections. Education and flank discussion of HPV-related diseases can set the foundation for understanding the role and potential benefits of HPV vaccines.

The first step toward helping our patients accept a new vaccine is to identify what people need to know about HPV, the diseases it causes, and the benefits of being vaccinated vs the risks associated with not being vaccinated. Educational efforts will also need to be directed toward the concerns of the parents of adolescents who could be the major beneficiaries of an HPV vaccination program. Finally, the psychosocial issues of symptomatic HPV infection and of potential target populations receiving the vaccine need to be discussed. Clearly, vaccination has been a successful prevention strategy for many diseases and has made the incidence of viral infections such as polio and smallpox a thing of the past.

What do women want to know about HPV?

Studies show that few individuals have a clear understanding of HPV and the consequences of infection. (1) Literature analyzing the concerns of women and their desire for information regarding HPV is limited. In a recent study, Anhang et al attempted to identify the most relevant educational information desired by women about HPV and HPV testing. (2) Forty-eight participants were included in this study; subjects were low-income, ethnically diverse women stratified by age (18-29, 30-54, and [greater than or equal to] 55 years). Study participants were asked to respond to a series of questions and paragraphs regarding many aspects of HPV infection. Incredibly, only 27% of the participants were familiar with HPV before the start of the focus group, even though 85% had received a Papanicolaou (Pap) test in the 2 years prior to the study. The principal information about HPV that women desired was related to transmission, prevention, treatment, and the degree of cervical cancer risk. Although information regarding these core areas was desired by women, regardless of age or ethnicity, women of different age-groups expressed some distinct interests. Typically, younger women focused on the symptoms associated with low-risk HPV infection, particularly the types that cause genital warts. Conversely, older women expressed concern about high-risk HPV infection, notably since high-risk HPV types are associated with cervical cancer. Across all age-groups, women were specifically interested in determining their personal HPV infection status and gaining a better understanding of risk factors (eg, age, sexual behaviors, sexual behaviors of previous sexual partners, and immunologic status) that contribute to susceptibility.

One of the findings of the study is that some women's fears centered on the lack of infallible techniques for the prevention of HPV transmission. This may be important in educating women about HPV vaccines since they could prevent the majority of the serious sequelae of HPV infections by the serotypes present in the vaccine. Although HPV vaccines are not infallible because they don't cover all HPV types, they may give women some comfort and a sense of control over the disease. Women also expressed confusion regarding HPV biology. Many women in the study had difficulty understanding the difference between low-risk and high-risk HPV types. Their confusion translated into uncertainty regarding the level of anxiety they may have if diagnosed with HPV. Some women were unclear about how HPV could be asymptomatic and how it could cause cervical cancer. However, most women felt the need to determine their HPV status, if possible.

Many women were confused by the…