Sexual Taboos, Racial Disparities and the HPV Vaccine

gardasil_vaccine_and_box_newBy Matt Wood

The human papillomavirus (HPV) is a strikingly common sexually transmitted disease associated with cervical cancer. More than 25 percent of women ages 14-59 are infected with HPV, but it gained greater attention in the United States in 2006 when the Food and Drug Administration (FDA) approved the first vaccine for it.

African American women and those living in low-income environments are at greatest risk for HPV infection and cervical cancer, and while some studies have looked at vaccination rates among adolescents, few have studied the unique effects of race and income level. To address this gap, a developmental psychopathologist at the University of Chicago recently studied the vaccination rates in a large, representative sample of girls 12- to 15-years old. She found that African American girls are far less likely to be vaccinated than European Americans, even when controlling for income level, exposing a significant disparity for those most at risk from HPV.

Kathryn Keenan, PhD, professor of psychiatry and behavioral neuroscience, had been working with colleagues at the University of Pittsburgh on a long-term study of the development of behavioral and emotional problems of almost 2,500 girls and their caregivers. In 2008, two years after the FDA approved the HPV vaccine, she and her colleagues took the opportunity to survey this group about initiation of the HPV vaccine.

The sample of girls in this study is unique because it is representative of the city of Pittsburgh and includes equal numbers of African Americans and European Americans. Because data had been collected annually since the study began in 2000, Keenan and her colleagues were able to identify predictors of which girls were most likely to get the vaccine.

In their latest study, published in Health Psychology, they found that about 60 percent of the girls had gotten the first of three shots for the HPV vaccine in the previous year, far below the goal of 90 percent set by the Centers for Disease Control and Prevention (CDC). African American girls were close to 40 percent less likely to have received the vaccine than European-American girls. The likelihood of vaccine uptake also increased with the level of sexual activity.

Keenan said these findings are troubling for a number of reasons. “African American women are more likely to suffer high levels of morbidity and mortality from cervical cancer than European American women,” she said. “So now we have something that in some ways should be deployed even more aggressively in that community and it’s not happening.”

The CDC recommends that all 11- or 12-year-old girls get the vaccination to protect against cervical cancer, but these recommendations have become a political issue as many parents and politicians object to the idea of protecting young children from a sexually transmitted disease. Unfortunately, this obscures the need for better education about HPV.

“Talking about sex and sexual activity when it comes to younger girls is still a huge taboo,” Keenan said. “I think we’re very uncomfortable thinking about sexual behavior in children. There are myths about how talking to children about sex gives them permission to have sex, and the data don’t support that at all.”

Keenan said that this fear overshadows the risks of HPV, because the public still has difficulty connecting it to cervical cancer. That confusion can give people the impression that there is a choice. “If you don’t have a good sense of the threat, it’s pretty easy to just say, ‘Well, it’s my choice,'” she said.  “I think we have to do a better job of making it clear that this is a real risk, and this is a real threat, because I don’t think that message is getting out.”

Keenan believes that the best way to ensure that girls get the vaccine is to administer it through schools, but admits that this would be difficult given the political challenges. As a follow up to this study, she is returning to the same sample of girls from Pittsburgh to assess whether or not they completed taking the HPV vaccine, and to ask their caregivers about their knowledge of the connection to cervical cancer and their attitude toward vaccination in general. This should help her understand more about how race affects use of the vaccine.

“We can ask a lot of questions within this data set because we have everything but the kitchen sink,” she said. “We know something about the neighborhoods they live in and how much violence there is in the neighborhoods. There could be a lot of other social factors that make it hard for people to address these basic preventative care strategies.”

The core of the problem, however, may be one of education about availability of the vaccine. “The other thing that we’re getting information on now is understanding whether people know they have access to the vaccine. That may be part of the problem,” Keenan said. “We shouldn’t accept just 60 percent of girls getting the vaccine when it’s available to everybody.”

Keenan, K., Hipwell, A., & Stepp, S. (2012). Race and sexual behavior predict uptake of the human papillomavirus vaccine. Health Psychology, 31 (1), 31-34 DOI: 10.1037/a0026812

About Matt Wood (531 Articles)
Matt Wood is a senior science writer and manager of communications at the University of Chicago Medicine & Biological Sciences Division.
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