Attitudes towards Human Papilloma Virus Vaccination in the Latin American Andean Region

Acceptability of humanpapilloma virus (HPV) vaccination hinges on beliefs regarding vaccination in general, attitudes towards sexuality and sexually transmitted infections (STIs), and attitudes towards cancer prevention. In addition to detailing the distribution of HPV and HPV-related diseases in the Latin American Andean region, this review article explores factors affecting attitudes towards HPV, HPV-related diseases, and HPV vaccination in that region. The premise is that lack of knowledge of HPV, known negative attitudes, or incorrect assumptions about HPV, HPV-related diseases, and HPV vaccination provide a basis upon which to develop targeted HPV awareness and preventive health media campaigns.

Author Oroma Nwanodi searched the PubMed database in January 2016 and June 2017, using the Andean nations Bolivia, Chile, Colombia South America, Ecuador, or Peru, followed by the terms "HPV", "HPV vaccine", "HPV vaccination", "HPV attitudes", "HPV vaccine attitudes", and "HPV vaccination attitudes", selecting for human subjects. These searches yielded 276 articles, 45 of which are incorporated into this review article and summarised in Table 2.

Summary of results related to awareness and attitude, by country:

• Chilean adolescents are aware that multiple sexual partners are a cervical cancer (CC) risk factor (70.8%) and an HPV infection risk factor (78.3%). While 68.2% are aware that unprotected sex facilitates HPV transmission, only 31.1% used condoms.
• Prior to school-based HPV vaccination in Colombia in 2012, only 44% of Colombian women aged 18 to 69 years old were aware of HPV, and only 25% of these women were aware of HPV vaccination. HPV vaccination is perceived as a means to control one of many STIs, but not as the best primary prevention of CC. The effect of high school or higher education on HPV knowledge is significant (p = 0.006). Colombians are more likely to learn about HPV and the HPV vaccine from social contacts (72.4%, 44.8%), educational establishments (77.8%, 50%), and the media (82.25%, 59.8%), than from health personnel (53.6%, 42.9%). Colombian women give illness (83%) and CC prevention (28.9%) as reasons why they received HPV vaccination [20]. HPV vaccination was declined for lack of information (30%), impaired access (28.9%), unknown reasons (21%), and neglect (20%).
• Peruvian mothers are the primary vaccination decision maker in Peruvian households, with fathers having input. There was very limited fear that HPV vaccination would provoke sexual disinhibition. Peruvian policymakers have contradictory opinions regarding the importance of CC to the public and in terms of health care system priorities. It is opined that if Peruvian CC statistics were perceived to be accurate, then CC would be of higher priority. Participation of religious leadership in vaccination promotion programmes may allay Peruvians distrust of vaccination. Therefore, a successful vaccination programme needs appropriate communication, well-educated vaccinators, and transparency in vaccine administration highlighting single use syringes and use of vaccine prior to expiration.

Table 3 in the review article presents a comparison of data on attitudes towards HPV and HPV vaccination across Andean nations. It can be seen that rural to urban, lower to higher socioeconomic group, gender, and linguistic differences exist within Colombia and Peru. Healthcare policymaking level differences compound these differences. Qualitative research regarding attitudes to and knowledge of HPV, HPV-related diseases, and HPV vaccines appears to be lacking for Bolivia and Ecuador. Dr. Nwanodi indicates that new research studies should be planned in the context of the extant literature; this may facilitate the formulation of effective HPV vaccination programmes in Bolivia and Ecuador and help to address any HPV vaccination issues that may be specific to the Andean region.

Dr. Nwanodi suggests that increased knowledge of HPV, HPV-attributable diseases, and prophylaxis thereof requires education. Research indicates that increasing HPV knowledge serves to increase HPV vaccine acceptability and openness to CC screening. Therefore, she argues, more culturally and linguistically appropriate general HPV public education should occur for all social groups and all sexual orientations. For example, while female sex workers (FSW) in Peru can receive sexual health education through the special clinic from which health cards are received, men who have sex with men (MSM) and transgender women (TW) do not access the public system in the same manner as FSW. Public health education media campaigns, photo- and telenovellas, and radio advertisements should run in both Spanish and Quechua, according to Dr. Nwanodi. Preventive health and vaccinations in general, as well as health clinic use, can be promoted by media campaigns. Additional programming can be developed for clinics to use in-house with their clients. Dr. Nwanodi contends that ministries of education, finance, and health all have roles to play to increase national HPV, HPV-related diseases, and HPV vaccination awareness.

Colombian data show that most knowledge of HPV and HPV vaccination derives from media campaigns, followed by educational establishments. Therefore, Dr. Nwanodi concludes, "health care organizations need to increase efforts to correctly inform unvaccinated patients about HPV and HPV vaccination at every encounter. Similarly, clinic- and school-based HPV vaccination promotion efforts could be increased in quantity and effectiveness. Implementation of HPV vaccination programs may be advanced if locally- and nationally-prominent persons, including politicians and their partners become advocates for HPV vaccination programs."