In this Issue:
How many times have you met with a first-time pregnant Latina client and found out that she has never had a Pap test? For many Latinas, pregnancy is the first entry into the healthcare system and the first opportunity to learn about preventable practices, including Pap tests and the human papilloma virus (HPV) vaccine. Sharing this information with Latinas is crucial since this group continues to be disproportionately affected by cervical cancer. Latinas are most likely to have low rates of cervical cancer screenings (Pap tests) and be diagnosed at an advanced stage of cervical cancer.
Cervical cancer is preventable and we need to make sure that Latinas are well informed. For Latina mothers, knowing more about HPV and the HPV vaccine can help them make an informed decision regarding vaccinating their teenage daughters. One focus group study of Latina immigrants in Alabama found that Latinas would generally accept the vaccine if they knew enough about it. These Latinas stressed the importance of hearing about the HPV vaccine from credible sources (doctor’s offices, television, churches and other women). Bringing up the topic with all of your clients is a way to bring it to the forefront.
HPV is the main cause of cervical cancer. However, there is a lot of confusion about HPV and the HPV vaccine. Take the time during January, Cervical Health Awareness Month, to share this information with all of your clients, particularly your Latina clients.
Key Points to Share With Your Latina Clients
Not all HPV types are created equal
There are over 100 types of HPV and more than 40 of them are spread through genital contact. Among these more than 40 types, are “high risk types” that cause cancers. Two types (16 and 18) cause about 70% of cervical cancer. The HPV vaccines Gardasil and the newly approved Cervarix (approved October 2009) protect against these two types. “Low-risk” types cause genital warts and are very common. The vaccine Gardasil protects against two of the most common “low risk” types (6 and 11).
The sleeping virus
HPV infections are very common and according to the Centers for Disease Control and Prevention (CDC), about 80% of women will be infected by HPV at some point in their lives. Many HPV infections are asymptomatic and clear up on their own so many women never even know they have had HPV. HPV can remain dormant for many years and it is impossible to determine when and from whom a person got the virus. This is important to mention to clients who may be shocked to find out they have an abnormal Pap test and have a long-time stable partner.
Condoms help but are not infallible
The use of condoms is recommended to protect against sexually transmitted infections. One study found that transmission of HPV can be reduced by 70% when condoms are used consistently. However, because HPV infections can exist in areas not protected by the condom, HPV transmission is still possible.
Knowing your HPV status
Unlike HIV, we cannot recommend that all clients find out their HPV status. First, there is no HPV test for men, so a woman can’t have her partner tested to be sure he is HPV-free. Second, the only FDA approved test for HPV is currently only approved for cervical cancer screening in women 30 years or older. Because HPV is so prevalent among women under age 30 and because it often clears up on its own, testing is not routinely recommended.
Treat the symptoms
HPV cannot be treated, but the early detection and treatment of abnormal cells and adherence to recommended screenings and procedures can help prevent cervical cancer.
Vaccination does not translate into sexual activity
The controversy surrounding the HPV vaccine revolves around the fact that the vaccine is indicated for girls 11 to12 years old, preferably before they become sexually active. For many parents, giving a vaccine to protect against a sexually transmitted infection to their pre-adolescents raises red flags. Explaining to parents that the vaccine will protect their daughters for the rest of their lives is important. Considering HPV is such a common infection, getting the vaccine is a way to protect their daughters for when they do become sexually active. Explaining the facts about HPV may help parents feel more at ease.
Facts about the vaccine
The HPV vaccine is on the recommended schedule for adolescents, but it is not required. Three doses of the vaccine are needed and can be administered to girls as young as 9 up to 26 years old. The cost of the vaccine can be daunting for most people (about $360 for all three doses) but especially for Latinas who make up a large percentage of uninsured women in our state. However, in North Carolina, the vaccine is available free or at low cost through the Vaccines for Children Program for most girls 9 to 18 years of age who are uninsured, Medicaid eligible or underinsured. For additional information visit http://www.hpvvaccineproject.org/hpv.php?page=providers_resources
HPV Vaccine and legal residence
Up until December 2009, any immigrant woman seeking to obtain her permanent legal residence in the United States was required to obtain the HPV vaccine. The CDC rescinded this requirement which was considered by many immigrant advocates as an unfair burden on immigrant women and girls. After December 14, 2009 immigrant women and girls do not have to obtain the HPV vaccine to complete their application for permanent residence. More information is available at http://www.cdc.gov/ncidod/dq/laws_regs/fed_reg/vaccine/revised-vaccination-immigration-faq.htm#december
Recommendations to Bridge the Gap
In the US:
In North Carolina:
Health Resources en Español
5 Useful Spanish Phrases