Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations

Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets

To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.

'I never realised that sex between two women was not safe': narratives of lesbian safer sex

This paper explores the way in which some lesbians rely on culturally circulated narratives about identity to assess safer sex and their potential risk of sexually transmitted infection (STI) and HIV. A well-established narrative within the literature about lesbian safer sex is that STI risk is non-existent. The implications of this are important because they demonstrate the perception of lesbian identity and notions of safety. This study focuses on how gender and sexuality contextualise an assessment of risk and safety for lesbians. This is vital to understand because there is still a lack of language about lesbian safer sex practices and techniques. Lesbians narrate their assessments of STI and HIV risk through the lenses of gender and sexuality - locating 'risk' in gay men and bisexual women. Using narrative analysis, I find that lesbians assess their risk by constructing characters from culturally circulated narratives steeped in homophobia and biphobia of the sensible lesbian, the risky gay man and the uncertain bisexual.

Human Papillomavirus Risk Perceptions Among Young Adult Sexual Minority Cisgender Women and Nonbinary Individuals Assigned Female at Birth

CONTEXT

Some sexual minority women may be less likely than other women to engage in human papillomavirus (HPV) prevention behaviors. Although risk perceptions have been found to be associated with health behaviors, HPV risk perceptions among U.S. sexual minority women have not been examined.

METHODS

In 2016-2017, in-depth interviews were conducted in Boston with 29 sexual minority individuals aged 18-36 who were assigned female at birth (AFAB) and identified as women or nonbinary. Purposive sampling was used to recruit participants online, through community-based and student organizations, and by word of mouth. Thematic analysis was employed to examine participants' HPV risk perceptions.

RESULTS

Participants incorrectly linked HPV risk to the exchange of genital fluids, and a hierarchy of perceived risk emerged in relation to sexual orientation: Individuals who engage in penile-vaginal sex with partners who were assigned male at birth (AMAB) were perceived to be at highest risk, and lesbians and individuals with only AFAB partners were perceived to be at low risk. Lesbians and participants with only AFAB partners identified sex with bisexual women or AFAB individuals with AMAB partners as a risk factor for HPV infection. Risk perceptions were shaped by health care providers' linking HPV risk to sex with AMAB individuals, a lack of discussion of HPV with parents and peers, and the exclusion of information on HPV and sexual minority women from school-based sex education.

CONCLUSION

Interventions providing sexual minority AFAB individuals with comprehensive, accurate and tailored information about HPV risk are needed.

Factors involved in human papillomavirus (HPV) vaccine hesitancy among women in the South-East Asian Region (SEAR) and Western Pacific Region (WPR): A scoping review

A scoping review was performed to identify factors that may lead to human papillomavirus (HPV) vaccine hesitancy among women in low- and middle-income countries in South East Asian Region (SEAR) and Western Pacific Region (WPR). A systematic search of English and non-English articles using Pubmed, EMBASE, PsycINFO, Cochrane, MEDLINE, and CINAHL plus was conducted. Only 63 studies conducted in SEAR and WPR were included from inception until December 2016. Results of these studies have shown that poor awareness and knowledge of practices on cervical cancer prevention was evident in both SEAR and WPR. Concerns on safety and efficacy of the vaccine, and costs in getting vaccinated were significant barriers. Most women stated that they needed more information, and strongly welcomed a physician's recommendation in both geographical regions. Women also felt they have a low risk of acquiring HPV infection and cervical cancer. Most women in SEAR and WPR were unable to decide on whether to accept HPV vaccination.

The Sexual Health of Women in Lebanon: Are There Differences by Sexual Orientation?

PURPOSE

From studies conducted in Western countries (United States, United Kingdom, and Australia), we know that the sexual health of sexual minority women (SMW) differs in key ways from that of heterosexual women (HSW). To date, the sexual health of SMW living in the Middle East and North Africa region has not been studied. The purpose of this study was to compare the sexual health of SMW and HSW living in Lebanon.

METHODS

SMW and HSW living in Lebanon (N = 95) completed an anonymous, self-administered survey. SMW's risk perceptions and health promoting and sexual behaviors were compared to those of HSW. We examined differences by sexual orientation by using t tests and Fisher's exact tests.

RESULTS

The 45 SMW and 50 HSW had similar demographic characteristics. Significantly more SMW had heard of human papillomavirus, but only 22% of women from both groups knew of its association with abnormal Papanicolaou tests. Cervical cancer screening rates were similar in SMW and HSW, although remarkably low (42%) compared with rates in Western countries. Significantly more SMW (18%) reported difficulty with access to care than HSW (0%). Forty-four percent of SMW reported discomfort in disclosing their sexual orientation to their healthcare provider and 61% reported that healthcare providers lacked sensitivity toward lesbian, gay, bisexual, and transgender needs. Unwanted sexual contact occurred more frequently in SMW (53%) than HSW (23%).

CONCLUSION

The sexual health of women is affected by sociocultural factors. SMW living in Lebanon have unique health needs that should be addressed within their sociocultural context.

Correlates of Human Papillomavirus Infection Among a National Sample of Sexual Minority Women

BACKGROUND

Many sexual minority women are infected with human papillomavirus (HPV), yet little is known about correlates of HPV infection among this population.

MATERIALS AND METHODS

We analyzed data from a national sample of sexual minority women (i.e., women who either reported a history of female sexual partners or identified as nonheterosexual) aged 20-59 from the 2003 to 2012 National Health and Nutrition Examination Survey (n = 830). Weighted logistic regression identified correlates of infection with any HPV type and infection with a high-risk HPV type.

RESULTS

About 53% of women were infected with any HPV type, and about 37% were infected with a high-risk HPV type. Women who reported five or more sexual partners during their lifetime (adjusted odds ratio [aOR] = 5.07, 95% confidence interval [CI]: 2.26-11.42) were more likely to be infected with a high-risk HPV type. Compared to women aged 20-29, women aged 40-49 (aOR = 0.51, 95% CI: 0.32-0.81) or 50-59 (aOR = 0.27, 95% CI: 0.14-0.53) were less likely to be infected with a high-risk HPV type, as were women who were married or living with a partner (aOR = 0.62, 95% CI: 0.44-0.89). Mostly similar correlates were identified for infection with any HPV type, although infection with any HPV type was also less common among women who identified as lesbian compared to those who identified as heterosexual (aOR = 0.38, 95% CI: 0.21-0.68).

CONCLUSIONS

Demographic and health-related characteristics were associated with HPV infection outcomes. Findings can inform HPV prevention efforts for sexual minority women by providing information about risk factors and subgroups at particular risk for infection.

Sexual orientation and sexual health services utilization among women in the United States

Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15-44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37-1.89), HIV (1.66; 1.29-2.14), and HPV (1.79; 1.41-2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76-1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10-1.86) and HIV (1.69; 1.24-2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47-0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07-0.28) and Pap (0.10; 0.03-0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.

A brief information-motivation-behavioral skills intervention to promote human papillomavirus vaccination among college-aged women

Background

Human papillomavirus (HPV) is prevalent among college-aged women. Although HPV vaccines decrease women’s risk for cervical cancer, the vaccination rates remain inadequate.

Objective

This study explored the utility of an information–motivation–behavioral skills (IMB) intervention in promoting HPV vaccination knowledge, motivation, and intentions among college-aged women.

Methods

In Spring/Fall 2012, 62 participants were randomly assigned to a single-session intervention or attention control and were assessed baseline, post-intervention, and at 1 month.

Results

The participants demonstrated adequate baseline vaccine knowledge, low HPV/cancer knowledge, and ambivalence about the vaccination. Post-intervention, the IMB arm demonstrated increased HPV/cancer and vaccination knowledge, motivation, and intentions. There were no group differences in vaccination at 1 month; however, the odds of wanting to get vaccinated increased sevenfold in the IMB arm.

Conclusion

These results provide preliminary support for an IMB-based intervention in increasing vaccination knowledge, motivation, and intentions among at-risk women. Future research examining the efficacy of longer trials with larger, diverse populations is warranted.

HPV infection among a population-based sample of sexual minority women from USA

OBJECTIVES

Sexual minority women are at risk for infection with human papillomavirus (HPV); yet, relatively little is known about the prevalence of HPV infection among this population.

METHODS

We analysed data from the 2003-2012 National Health and Nutrition Examination Survey among women aged 20-59 (n=7132). We examined two dimensions of sexual orientation (sexual identity and sexual behaviour) and used weighted logistic regression to determine how HPV infection outcomes (any HPV type, high-risk HPV type and vaccine HPV type) vary by dimension.

RESULTS

Similar patterns emerged for sexual identity and sexual behaviour. In bivariate analyses, HPV infection outcomes were more common among non-heterosexual women compared with heterosexual women (any type: 49.7% vs 41.1%; high-risk type: 37.0% vs 27.9%), as well as among women who reported any same-sex partners compared with women who reported only opposite-sex partners (any type: 55.9% vs 41.0%; high-risk type: 37.7% vs 28.2%; vaccine type: 19.1% vs 14.0%) (p<0.05). When we disaggregated measures of sexual orientation into subgroups, bisexual women and women who reported partners of both sexes had greater odds of HPV infection outcomes (p<0.05 in bivariate analyses). Multivariate models attenuated several of these differences, though lesbian women and women who reported only same-sex partners had lower odds of most HPV infection outcomes in multivariate analyses (p<0.05).

CONCLUSIONS

HPV infection is common among sexual minority women, though estimates vary depending on how sexual orientation is operationalised. Results can help inform targeted HPV and cervical cancer prevention efforts for sexual minority women.

Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls: A National Survey

BACKGROUND

Lesbians and bisexual women are at risk for human papillomavirus (HPV) infection from female and male sexual partners.

OBJECTIVE

To examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls.

DESIGN

Cross-sectional, using 2006-2010 National Survey of Family Growth data.

SETTING

U.S. civilian noninstitutionalized population.

PARTICIPANTS

The 2006-2010 National Survey of Family Growth used stratified cluster sampling to establish a national probability sample of 12,279 U.S. women and girls aged 15 to 44 years. Analyses were restricted to 3253 women and girls aged 15 to 25 years who were asked about HPV vaccination.

MEASUREMENTS

Multivariable logistic regression was used to obtain prevalence estimates of HPV vaccine awareness and initiation adjusted for sociodemographic and health care factors for each sexual orientation identity group.

RESULTS

Among U.S. women and girls aged 15 to 25 years, 84.4% reported having heard of the HPV vaccine; of these, 28.5% had initiated HPV vaccination. The adjusted prevalence of vaccine awareness was similar among heterosexual, bisexual, and lesbian respondents. After adjustment for covariates, 8.5% (P = 0.007) of lesbians and 33.2% (P = 0.33) of bisexual women and girls who had heard of the vaccine had initiated vaccination compared with 28.4% of their heterosexual counterparts.

LIMITATION

Self-reported, cross-sectional data, and findings may not be generalizable to periods after 2006 to 2010 or all U.S. lesbians aged 15 to 25 years (because of the small sample size for this group).

CONCLUSION

Adolescent and young adult lesbians may be less likely to initiate HPV vaccination than their heterosexual counterparts. Programs should facilitate access to HPV vaccination services among young lesbians.

PRIMARY FUNDING SOURCE

National Cancer Institute.

Lesbians' attitudes and practices of cervical cancer screening: a qualitative study

Background

Cervical cancer is the third most prevalent cancer in women, and since the introduction of the Papanicolaou test (Pap test or Pap smear), the incidence of cervical cancer and mortality rates worldwide have declined substantially. However significant disparities have been identified between the cervical screening rates of heterosexual and lesbian women. This study explores the attitudes and practices that lesbians have towards cervical cancer screening and aims to identify why such disparities occur.

Methods

A qualitative methodology based on feminist perspectives was used to collect narrative data from lesbians about their attitudes and practices of cervical screening through the use of semi structured interviews. Nine women who self-identified as lesbian that were living in New South Wales were recruited for the study. Interviews were digitally recorded and transcribed verbatim. Data were analysed using a thematic analysis approach.

Results

Four main themes emerged from the data namely: Encountering cervical cancer: “my friends had some early cancer cells detected”, Misconceptions related to risk: “I am a lesbian I don’t need one”, Imposed screening: “It’s a requirement of IVF treatment” and, Promoting cervical screening: “I think it should be spoken about in schools”.

Conclusions

Consistent with the literature, the findings show that the majority of these women do not undertake cervical screening at the recommended rate. This study highlights the multiple and complex issues related to cervical cancer screening for lesbians, mainly through misconceptions and underestimation of risk. Specific and targeted educational and promotional strategies are required for both lesbians and health professionals to enhance cervical cancer screening rates for lesbians in Australia.

The association of human papillomavirus vaccination with sexual behaviours and human papillomavirus knowledge: a systematic review

Since the 2008 introduction of the human papillomavirus (HPV) vaccination programme for adolescent girls in the UK, parents and other groups have expressed fears that immunisation condones sexual activity, promotes promiscuity and encourages risky sexual behaviour. This study aimed to explore whether HPV vaccination programmes have increased knowledge surrounding HPV and associated disease and whether uptake has influenced sexual behaviour. MEDLINE, Embase, Cochrane Library and PsycINFO electronic databases were interrogated. Studies of behaviour, attitudes and knowledge associated with HPV vaccination (or vaccination intent) in subjects of any age and gender in programmes reflective of UK practice were included in the review (n = 58). The evidence regarding the association of HPV vaccination with high-risk sexual behaviour was varied, primarily due to the heterogeneous nature of the included studies. Young females typically exhibited better knowledge than males, and vaccinated respondents (or those with vaccination intent) had higher levels of knowledge than the unvaccinated. However, knowledge surrounding HPV and genital warts was generally poor. This review highlights the need to provide effective education regarding the HPV vaccine and HPV-associated disease to adolescents of vaccination age, nurses, teachers, parents and guardians to ultimately allow informed decisions to be made regarding receipt of the HPV vaccine.

Factors related to Israeli lesbian women's intention to be vaccinated against human papillomavirus

Summary

Lesbian women's susceptibility to human papillomavirus infection and, as a consequence, to cervical cancer, is similar to that of heterosexual women. However, little is known about factors related to lesbian women's intention to be vaccinated against human papillomavirus. The aim of the study was to identify factors related to Israeli lesbian women's intention to be vaccinated, using the Health Belief Model. The study has a cross-sectional design. A convenience sample of 207 lesbian women recruited at clubs in central Israel's lesbian community completed a questionnaire, based on the Health Belief Model. Thirty-two percent of the respondents reported having a high intention to be vaccinated. Perceived susceptibility to cervical cancer and perceived benefits of human papillomavirus vaccination were found to be related to intention to be vaccinated. The findings offer insights that can inform health care providers of strategies to promote vaccination against human papillomavirus in this unique population.

Human papillomavirus infection: knowledge, attitudes, and behaviors among lesbian, gay men, and bisexual in Italy

BACKGROUND

This cross-sectional study assess knowledge, attitudes, and behavior towards the human papillomavirus (HPV) and the vaccination among a random sample of 1000 lesbian, gay men, and bisexual women and men.

METHODS

A face-to-face interview sought information about: socio-demographic characteristics, knowledge about HPV infection, perception of risk towards HPV infection and/or cervical, anal, and oropharyngeal cancers, perception of the benefits of a vaccination to prevent cervical, anal, and oropharyngeal cancers, sexual behaviors, health-promoting behaviors, and willingness to receive the HPV vaccine.

RESULTS

Only 60.6% had heard about the HPV infection and this knowledge was significantly higher in female, in those being a member of a homosexual association, in those having had the first sexual experience at a younger age, in those having received information about the HPV infection from physicians, and in those having no need of information about HPV infection. A higher perceived risk of contracting HPV infection has been observed in those younger, lesbian and gay men, who have heard of HPV infection and knew the risk factors and its related diseases, who have received information about HPV infection from physicians, and who need information about HPV infection. Only 1.7% have undergone HPV immunization and 73.3% professed intent to obtain it in the future. The significant predictors of the willingness to receive this vaccine were belief that the vaccination is useful, perception to be at higher risk of contracting HPV infection, and perception to be at higher risk of developing cervical, anal, and oropharyngeal cancers.

CONCLUSIONS

Information and interventions are strongly needed in order to overcome the lack of knowledge about HPV infection and its vaccination. Inclusion of boys in the national vaccination program and initiate a catch-up program for men who have sex with men up to 26 years may reduce their burden of HPV-related disease.

Are women ready for the new cervical screening protocol in England? A systematic review and qualitative synthesis of views about human papillomavirus testing

BACKGROUND

A new protocol for human papillomavirus (HPV) testing within the UK cervical screening programme commenced in April 2011, creating new patient experiences. This is the first review to synthesise a substantial body of international evidence of women's information needs, views and preferences regarding HPV testing. We aimed to inform the development of educational materials to promote informed choice, reduce anxiety and improve disease control.

METHODS

We searched 12 bibliographic databases. Two reviewers independently screened papers and assessed study quality; disagreements were resolved by discussion. Results were extracted verbatim and authors' findings treated as primary data. Studies were synthesised collaboratively using framework methods.

RESULTS

We synthesised findings from 17 studies. Women had overwhelmingly negative concerns; an HPV diagnosis was daunting, had associated problems of disclosure of a sexually transmitted infection (STI), impacted on relationships and provoked fear of stigmatisation. Nevertheless, many thought HPV testing could be a preferable alternative to repeat cytology. Knowledge was poor; women struggled to interpret limited information in the context of existing knowledge about STIs and cervical cancer.

CONCLUSION

Women are likely to be poorly informed, have limited understanding and many unanswered questions. This could increase anxiety and reduce ability to make informed choices, presenting a substantial challenge for those who design and provide information.

Adolescent Understanding and Acceptance of the HPV Vaccination in an Underserved Population in New York City

Background. HPV vaccination may prevent thousands of cases of cervical cancer. We aimed to evaluate the understanding and acceptance of the HPV vaccine among adolescents. Methods. A questionnaire was distributed to adolescents at health clinics affiliated with a large urban hospital system to determine knowledge pertaining to sexually transmitted diseases and acceptance of the HPV vaccine. Results. 223 adolescents completed the survey. 28% were male, and 70% were female. The mean age for respondents was 16 years old. Adolescents who had received the HPV vaccine were more likely to be female and to have heard of cervical cancer and Pap testing. Of the 143 adolescents who had not yet been vaccinated, only 4% believed that they were at risk of HPV infection and 52% were willing to be vaccinated. Conclusions. Surveyed adolescents demonstrated a marginal willingness to receive the HPV vaccine and a lack of awareness of personal risk for acquiring HPV.

HPV vaccine promotion: does referring to both cervical cancer and genital warts affect intended and actual vaccination behavior?

BACKGROUND

young women have poor awareness that human papillomavirus (HPV) can cause both cervical cancer and genital warts, a sexually transmitted infection (STI). A newly developed HPV vaccine can provide protection against both cervical cancer and genital warts. This vaccine could be promoted by health authorities/professionals as preventing cervical cancer plus genital warts, or cervical cancer alone. Because stigma around STIs may reduce acceptance of the vaccine, the effect of information framing ('cervical cancer' versus 'cervical cancer plus genital warts') on intention to receive the HPV vaccine and actual uptake behavior was examined using the health belief model (HBM).

METHODS

we randomized 159 young women under the age of 27 to receive one of two variations of a fact-sheet describing the HPV vaccine as 1) preventing cervical cancer or 2) preventing cervical cancer and genital warts.

RESULTS

the results revealed low HPV knowledge (22%) and high HPV vaccination intention (79%), which was not influenced by information framing. Receipt of the vaccine at the 2-month follow-up was 37%, and was also not influenced by information framing. The overall HBM predicted vaccination intention (p < .001) and behavior (p = .002). However, only barriers (p = .029) and benefits (p = .001) independently predicted HPV vaccination intention; susceptibility (p = .023) and benefits (p = .033) independently predicted HPV vaccination behavior.

CONCLUSION

highlighting the sexual transmissibility of HPV does not seem to lower vaccination intentions or behaviors among young women. Potential challenges for promotion of the HPV vaccination program in Australia and worldwide are discussed.