BackgroundIn addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16–25 years who use the public health system in Brazil.MethodsThis was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire.ResultsOf 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70).ConclusionsThe results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies.

& pop-Brazil Study Group 1 † For Brazil, there are no nationwide data on HPV prevalence against which the impact of the HPV immunization program can be measured in the future. Therefore, we aim to evaluate the prevalence of genital HPV infection among adolescents and young adults in Brazil. A cross-sectional, multicentric, nationwide survey was conducted between September 2016 and November 2017. Sexually active unvaccinated women and men aged 16 to 25 years old were recruited from 119 public primary care units, including all 26 state capitals and the Federal District. All participants answered a face-to-face interview and provided biological samples for genital HPV analysis. We used an automated DNA extraction method and HPV genotyping was performed using the Linear Array genotyping test (Roche). Of 7,694 participants, 53.6% (95% CI 51.4-55.8) were positive for any HPV type. The prevalence of highrisk HPV types was significantly higher in women (38.6% vs. 29.2%, P < 0•001). The HPV types included in the quadrivalent vaccine were detected in 1002 (14.8%) specimens, with a different pattern of HPV infection between sexes. Characteristics associated with overall HPV detection included female gender, self-declaration of race as brown/pardo, lower socioeconomic class, single or dating, current smoking and having 2 or more sex partners in the past year. We found a high prevalence of HPV, with significant differences between regions. Our data provide information that may be considered when developing HPV prevention policies and constitute a baseline against which the impact of the HPV immunization program in Brazil can be measured in future years. Human papillomavirus (HPV) is globally the most common sexually transmitted infection 1 , and it is strongly associated with cervical, anogenital and oropharyngeal cancers 2,3. HPV is one of the main causes of mortality among women in underdeveloped countries 1,4,5. Although the prevalence of HPV has already been evaluated in some specific groups and regions, there are no data on HPV prevalence in young general populations of the different regions of Brazil 6. The prevalence and types of circulating HPV vary widely both among different populations and among age groups within populations. All regions of the world have shown an overall decline in prevalence according to age, except Latin America and the Caribbean, where the prevalence increases later in life, presenting a bi-modal distribution 1. In addition, the prevalence and type-specific HPV frequency can change according to race, with a higher incidence in indigenous 7 and black populations 8. The introduction of HPV vaccination is an opportunity to prevent infection and associated lesions, thus changing the patterns of mortality by cervical cancer. Brazil introduced an HPV immunization program using a quadrivalent vaccine in 2014 for children 9 to 14 years old and is currently adopting a 2-dose vaccination schedule (0-6 months) 9. Although vaccine efficacy in decrease cervical intraepithelial neoplasia has been demonstrated

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history.We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender.There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P < .001). The use of alcohol and drugs and the use of drugs before sexual intercourse impact in STIs equally between the genders. Exclusive for women, the presence of any STI was associated with the practice of vaginal sex and other types of intercourse (adjusted prevalence ratio [APR] 1.43, 95% CI 1.08–1.88). For men, the number of sexual partners in the last year (APR 1.02, 95% CI 1.01–1.04), not having vaginal sex (APR 3.25, 95% CI 1.78–5.92) and sexual experience with someone of the same sex (APR 4.05, 95% CI, 2.88–5.70) were associated with a higher presence of STIs.This is the first report regarding sexual behavior in a nationally representative population sample in Brazil. This study provides more valid estimates of sexual behavior and associated STIs, identifying important differences in sexual behavior and identifying predictors for referred STIs among females and males.

The proposed questionnaire is the first instrument able to describe the knowledge, beliefs and behaviors regarding HPV and related subjects in Brazilian women and men. This questionnaire appears to be adequate for use in future studies that may produce evidence and knowledge on these specific topics.

No abstract