Silent Stigma Against HPV and Genital Warts

Introduction

The scientific understanding of HPV infections acquired through sexual contact is a key medical breakthrough, allowing effective preventative and treatment measures against HPV infection and HPV-related cancers. On the flip side, this groundbreaking information also brings in its wake a stigma that is tagged along with the disease.

In this article, we would like to navigate along the unspoken stigma that makes us uncomfortable, the repercussions of this subtle stigma, and what we can do about it.

Stigma

Stigma is a Greek word. Among the old Greeks, stigma is a ‘brand’ or ‘tattoo’ carved out with sharp instruments to permanently mark those who are ‘criminals’, ‘ousted group’. Stigma differentiates those who are considered socially ‘normal’ and acceptable vs those who are ‘abnormal’.

Stigma revolving HPV diseases

(1)Poor Understanding of HPV diseases

It is commonly believed that HPV infections such as genital warts, cervical abnormalities and cervical cancers only occur in those with high risk sexual behavior.

It is commonly believed that ‘healthy’, ‘normal’, ‘monogamous’ couples should not have HPV infection.

HPV-related discussion, sexual health education remains taboo in current society.

Debunk: 

• HPV infections such as genital warts, cervical cancer can occur in anybody.
• Yes, the more sexual partner(s) one have, the earlier one is sexually active, history of smoking, poor immune system may predispose one towards HPV infection.
• Nevertheless, as HPV infection is transmitted through sexual contact, even monogamous couples may be exposed to HPV infections.

(2) Negative Social Views against those with HPV infections

Commonly having physical symptoms such as genital warts, HPV infections, cervical abnormalities can come in shock to most patients.

Contracting HPV infection can often lead to a lot of negative labelling.

Debunk: 

• While those with high risk sexual behaviors have a higher risk of contracting HPV infection, as long as one is in a sexual relationship (or before), one can potentially acquire HPV infection.
• Not everyone with HPV infection has symptoms, most people are carrier. Hence, even without physical symptoms, we may not be HPV-free. This does not give us any right to stigmatize those with HPV physical symptoms.
• According to CDC, nearly all sexually active person who are not vaccinated against HPV will have contracted HPV at some point of their lives. HPV is very common.

(3) Personal Stigma Against HPV infections

With the presence of physical HPV symptoms such as genital warts, or diagnosed with HPV-related illnesses such as cervical abnormalities, patients commonly experience low self -esteemed and self-conscious about the disease. One may feel upset, angry as to why such ‘disastrous’ infection befalls one, angry at the partner for passing the disease. Feeling of embarrassment, shame, self-blame, isolation is common when experiencing stigma. This leads to change of behavior, avoidance of socializing, internalizing and fear of others knowing about one's health conditions.

(4) Mental Health Strain

Combination of community belief, subtle judgement and discrimination against promiscuity, incomplete sexual education, inaccessibility towards the right knowledge and information, personal fear and stigma can eventually take a toll on our mental health. Chronic significant stigma against HPV infections can lead to a tumultuous mental stress and predispose one towards mood disorders such as anxiety and depression.

Implications of HPV Stigma

Progression of HPV-related medical complications

Due to stigma, one may turn a blind eye towards his or her health condition, decline to seek medical assistance. While HPV infection generally is benign, certain high-risk HPV strains can result on HPV-related cancers- such as cervical cancer, throat cancer, even skin cancers (vulva cancers, penile cancers or anal cancers). Furthermore, physical presence of HPV infection such as genital warts can be unsightly in appearance, and they can grow into a huge cluster of abnormal 'skin/ flesh'.

Delaying medical evaluation will lead to delay in diagnosis and treatment of HPV-related illness. It is worth noting that HPV infection, including HPV-related cancers, are one of the most preventable cancers if managed promptly.

Limited access to help

Because of the silent stigmatization against HPV, society may not be equipped with sexual health clinics or relevant medical services. Accessibility to the right health channel when need arises for HPV-related illness may be hampered. One is likely to be poorly informed of HPV conditions, uncertain where to seek medical help, or even feel too embarrassed to engage medical care.

Relationship and communication breakdown

Long term society pressure and stigma against HPV-related conditions, low esteem, fear and isolation can alter a person's social pattern, causing strain to relationship with others. Also, due to communication barriers secondary to stigmatization, one may not be able to inform their sexual partner(s) of potential risk of spread and transmission of HPV infection between sexual couples. Diagnosis and treatment of HPV-related condition are also delayed as a result of poor communication.

Hesitancy to receive medical treatment for HPV illnesses

Commonly one may find HPV vaccination as a preventative measure against HPV infection unnecessary as the vaccine is only targeted towards high-risk sexual behavior populations. One may also be defensive and hesitant for HPV checkup, HPV testing or even STD testing in view of the stigma associated with the tests. Such testing may imply engaging in immoral behaviors and abnormal HPV test results will then confirm their promiscuous acts.

Understanding The Impact of Silent Stigma On Medical management of HPV infection

Addressing the challenges pertaining to HPV stigmatization allows better control of HPV-related conditions, reduces impediments to healthcare accessibilities, provides equal healthcare HPV resources to everyone, and reduces risk of HPV-related complications and cancers.

Stigma against HPV, interestingly, does not just affect patients and family. Silent HPV stigmatization can be also seen among health care workers due to incomplete understanding of the HPV disease. This further impedes patients and public receiving prompt and correct education and medical intervention against HPV disease and progression.

Mitigating Stigma against HPV conditions

As a person:

Ensure receiving up-to-date health information regarding HPV

• Obtaining the right information from the correct medical sources regarding HPV can prevent further hear-say/ misinformation and misunderstanding regarding HPV conditions.
• Avoiding own online research, receiving information from social group, discussion, support groups.
• Some of the reliable medical sources include Medscape, Emedicine, CDC websites, etc.
• If in doubt, it is always useful to discuss your concerns and quarries with your healthcare providers.

Have an open and sincere conversation with sexual partner(s)

• An open, honest, non-judgmental, non-blaming conversation with sexual partner(s) are important in addressing HPV sensitive topics.
• Working out ‘disagreement’ or ‘concerns’ together with partner(s) constructively, rather than blaming one another.
• Empower each other in understanding HPV condition, ways to reduce risk of transmission and receive appropriate treatment timely to prevent further spread to partner(s).

As a society:

Our belief, society norms, and culture can affect a persons' attitude and behavior, there after as a rippling effect, influencing people around us.

Shifting the blaming culture to proactive prevention

• Highlight the importance of HPV vaccination and regular medical HPV screening in curtailing HPV-related medical conditions.
• Promoting preventative HPV vaccine and regular HPV screening as part of general medical checkup rather than ‘sexually-related’ concerns. This will aid ‘normalizing’ HPV checkup and vaccination.
• Understand that HPV is very common, and at some point of our lives, one can get infected by HPV as long as they are sexually active (before).
• Improve public awareness and education by ensuring public receive correct information about HPV via responsible channel and social platforms.
• Improve accessibility towards health services for HPV-related illness.

Final say…

By reinforcing the right attitude, mindset, debunking HPV myths at personal and societal level, we can strive towards managing HPV associated stigmas, thereafter empower one against HPV-related medical conditions.

I would like to end the article with a few key points of HPV that we commonly have misconceptions about:

• HPV is not just a woman's concern. Men can be HPV carriers and can be infected with HPV as well.
• Having HPV does not equates to being promiscuous, as everyone who is involved in a sexual relationship before, has potential to have HPV infection.
• HPV vaccination is not just for those who are engaged in high risk sexual behaviors, and should be offered to those age-eligible.
• While HPV can be a lifelong condition, HPV symptoms such as genital warts, early skin changes/ cervical changes are treatable and prompt treatment can halt further progression to HPV-related cancers.
• HPV vaccination is effective in prevention and reducing the risk of HPV-related illnesses including genital warts, HPV-related skin cancer, vulva and anal cancer and cervical cancer.

If you’re concerned about HPV or genital warts, know that you don’t have to face it alone. DB Clinic provides confidential consultations to help you better understand your options and next steps. Take the first step towards clarity and care—book an appointment here.

References:

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