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Duke University

Publication Date

Fall 2009

Program Name

Chile: Public Health, Traditional Medicine, and Community Empowerment

Abstract

Background: Efforts by the Chilean Ministry of Health to reduce the mortality rates due to cervical cancer by 40% during 2000 - 2010 have successfully impacted every age group except for young women between the ages of 20-24. Cervical cancer is caused by Human Papiloma Virus (HPV), the most common Sexually Transmitted Infection (STI). Both are detected by the Papanicolaou test, or Pap smear. Cervical cancer found in older women most likely developed from an HPV infection contracted in their youth. This study aims to understand the knowledge, practices, and perceptions that young women in Arica, Chile have about their sexual health that may be related to the rates of HPV infections and ensuing cases of cervical cancer. Methods: This study was conducted at the health clinic of a local university. In the waiting room, women were randomly approached until ten had been found who had initiated sexual relations but had not yet gotten a Pap smear. These ten women were interviewed about their sex education, knowledge about HPV, sexual activity, perceptions of risk of HPV infection, and knowledge and perceptions about Pap smears and campaigns promoting them. Their responses were analyzed to determine their level of knowledge of HPV and Pap smears and find relations between that, socio-cultural variables, sexual practices, and perceptions that might provide explanations for the high rates of HPV infection and new ways to decrease them. Results: Even the women who had received sex education knew little to nothing about HPV. Only one woman was able to correctly identify more than three facts about the virus. Six women knew that it is an STI, and four knew that it is related to cervical cancer, but only two people were able to identify any risk factors, and none knew that it is asymptomatic. Half of the women thought that Pap smears are used to detect cervical cancer, and two thought that they detect STIs. Only one woman knew that Pap smears are used to detect HPV. Their perceptions about Pap smears revealed that most had not gotten one because they did not perceive it as necessary yet, or had low personal risk perception. Six women reported sexual practices that raise their risk of HPV infection, including early sexual initiation, three or more sexual partners, random sexual partners, and not using a condom. Only one of them perceived risk of infection. Conclusions: The women’s poor knowledge of HPV, cervical cancer, and Pap smears revealed the inadequacy of the sex education imparted by schools. Sex education from families should also be promoted because mothers, as the person these women most often knew to have received a Pap smear, are in the ideal position to promote it to their daughters. Most young women perceive Pap smears as necessary but in the distant future, a possible reason why the existing promotion campaigns don’t seem to be working. These campaigns target the primary risk group, older women who may already have developed cervical cancer, which may explain why these young women associate Pap smears with cervical cancer and the distant future. An HPV prevention campaign emphasizing the risk of infections in young women, preferably similar to a widely recognized televised ad promoting the HPV vaccine, could potentially help lower the incidence rates of HPV infections and the ensuing cases of cervical cancer.

Disciplines

Community Health and Preventive Medicine | Public Health Education and Promotion

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