HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine

Abstract

Papua New Guinea has among the highest estimated burden of cervical cancer globally, but currently lacks national cervical screening or human papillomavirus (HPV) vaccination programmes. The Papua New Guinean government is committed to introducing the HPV vaccine for primary prevention, but locally-relevant research evidence is not available to guide implementation. Experience from earlier Papua New Guinean health programmes suggests that appropriate engagement with local health cosmologies and cultures for health/wellbeing, illness/disease, and recognition of the role of ‘outsiders’ in preventing, promoting or contributing to sickness, are essential to the successful introduction of biomedical interventions in this setting. We describe findings from a multi-site qualitative study undertaken in three provinces in Papua New Guinea (2012-14). Twenty-one gender specific focus group discussions and 82 semi-structured interviews, with a total of 208 participants, were conducted. There was strong community support for the introduction of the HPV vaccine for cervical cancer prevention in Papua New Guinea. Significantly, and despite being officially discussed in the context of a planned future intervention focusing on vaccinating young girls to prevent cervical cancer, the intervention was de-feminised, where both girls and boys were supported to be vaccinated in any HPV programme in Papua New Guinea.

Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review

“…These beliefs were particularly evident when concepts of cultural taboo were brought forth. For instance, despite overall support for vaccination in a community in Papua New Guinea, there were concerns expressed by community members about a perceived increase in promiscuity once disease protection was acquired from the HPV vaccine; some participants believed that there might be a community-wide increase in the sex trade [32]. In settings where public health messaging focused on the sexually transmitted nature of HPV, healthcare providers suggested that explicit discussions about sex were needed; such discussions was seen as problematic by Indigenous community members where cultural taboos about discussing matters related to sex, such as sexually transmitted infections (STIs), may persist (e.g., from cultural or historical factors).…”

“…Some Indigenous people in the literature were uneasy about the possibility of infertility or sterilization. Community participants in Papua New Guinea feared that the HPV vaccine would result in the destruction of reproductive organs and trigger additional complications resulting in infertility [32]. Other studies echoed concerns about infertility arising from the vaccine [41,45].…”

The diagnostic accuracy of TCT + HPV-DNA for cervical cancer: systematic review and meta-analysis

“…Thus, more and more attention has been paid to the early screening of cervical diseases in clinical practice, and more effective and reasonable examination methods have been developed to improve the accuracy of cervical disease diagnosis (21). Cervical cancer is the only gynecological cancer that can be diagnosed early and cured, and the early detection of pre-cancerous lesions is the key link in the prevention and treatment of cervical cancer (22)(23)(24)(25). Traditional cervical cancer screenings are aimed at the early detection of cervical cancer, while modern cervical cancer screenings are aimed at the early detection of high-grade CIN lesions and the early treatment of obstructive cervical cancer.…”

Sexual health and wellbeing training with women in Pacific Island Countries and Territories: a scoping review

“…Following the teachings of Freire and Boal, the use of theatre to educate, liberate and give community a voice to discuss specific concerns and health challenges can highlight information gaps and provide insight into how health information can be customised to address community needs [ 57 ]. In PICTs, where quality health information is often unavailable, communities rely on stories to make decisions regarding health behaviour [ 62 ]. According to Silver [ 56 ], storytelling as a method to effect health behaviour change requires only imagination and understanding of the cognitive frame of a particular community.…”