Exploring HPV Infections and Cervical Screening With Multiple Lenses
HPV is one of the most common sexually transmitted infections (STIs) and it is estimated that 70% to 75% of people will be infected over their lifetime. HPV infections can cause genital warts or cancers including cervical cancer. Most HPV infections will disappear on their own and regular cervical screening, most commonly using the Papanicolaou (Pap) test, can prevent cervical cancer by catching abnormalities early before they become cancerous.
A greater proportion of First Nations, Inuit, and Métis women are diagnosed with cervical cancer than women in the general population. Factors that may account for this are explored in two of the articles in this issue. The other articles explore ways to increase the acceptance of cervical screening among Aboriginal women, including an alternative method of screening and the creation of “ethical space.”
One of the themes of this issue is the influence of personal history on acceptance of HPV screening. The health of First Nations, Inuit and Métis people in Canada has been deeply impacted by colonization and its resultant intergenerational traumas. These traumas—and the general feeling of mistrust they caused—along with limited transport and child care support may represent barriers for accessing cervical screening. Elias and collaborators used the Manitoba First Nations Regional Longitudinal Health Survey to examine the association between traumatic life experiences (abuse, addiction, or other trauma) and access to healthcare, including cervical screening. They found that First Nations women who reported traumatic histories were more likely to have had a Pap test. This may be due to these women’s more frequent use of healthcare services, which in turn increased their likelihood of engaging in cervical screening.
On the other hand, Russell and Leeuw, who used a very different methodology to survey a small group of marginalized Aboriginal women living in northern British Columbia, identified traumatic life experiences as a barrier to cervical screening for many participants. Participants showed an increased awareness of HPV and cervical cancer after taking part in workshops that used creative arts to help convey the information. Their study also showed that healthcare provider sensitivity, access to culturally relevant education resources, child care support, and transportation are factors that may positively influence screening rates.
Cerigo and colleagues provided the results of their survey on the acceptance of and preference for selfcollection of cervicovaginal samples for HPV testing among a sample of Inuit women from Nunavik, Quebec. Their findings showed a preference for self-collection among the majority of participants, suggesting a better way to offer cervical screening to women who may be uncomfortable having a cervical sample taken by a healthcare provider.
Zehbe and colleagues investigated the foundation for the development of an “ethical space” in collaboration with First Nations communities in northwest Ontario. The authors used a participatory action research approach based on respectful and meaningful collaboration with First Nations women, healthcare providers, leaders, and other community members. Through a series of engagements with community members, the authors designed a study that was both scientifically sound and accepted by the communities involved.
While there are still gaps in our understanding of HPV and its impacts on First Nations, Inuit, and Métis people, this issue of the Journal expands our knowledge and points to possible best practices for the prevention of HPV-related diseases, including cancer. Notably, in the context of HPV infections and cervical screening, this issue highlights the importance of culturally relevant and gender-sensitive Exploring HPV Infections and Cervical Screening With Multiple Lenses This issue of the Journal of Aboriginal Health ( JAH) explores human papillomavirus (HPV) infections and cervical screening in First Nations, Inuit, and Métis populations from a holistic perspective. This vantage point recognizes that health is a balance among the physical, mental, emotional, and spiritual aspects of life. This issue also acknowledges that health is influenced by more than personal health practices, including socioeconomics, access to care, and other social determinants of health. Editorial 6 Journal de la santé autochtone, mars 2012 screening programs.
It is important to continue building partnerships to explore the acceptability, accessibility, understanding, and uptake of HPV immunization in First Nations, Inuit, and Métis communities. Available vaccines can prevent up to 70% of cervical cancers caused by HPV and are recommended for girls nine years and older, as well as males between nine and 26 years of age, including males having sex with males. Obstacles such as those identified in this issue’s studies may hinder the dissemination of knowledge about and access to HPV vaccination. However, the studies point to a number of ways to identify and mitigate barriers to HPV immunization, helping to bring good health closer to the grasp of Aboriginal women in Canada.
Integrated HPV Working Group of the Federal Government Editorial