Testing and Early Treatment: HPV & Cervical Cancer in Low-Resource Settings

Over the last several years, Gardasil and the concept of vaccinating against human papillomavirus (HPV) have gotten quite a lot of press here in the United States. But combating HPV and cervical cancer in developing nations is a whole other challenge.

More than a quarter of a million women die from cervical cancer every year, and 80% of those women are in the developing world. But cervical cancer is among the most treatable of cancers if it is caught early.

Yesterday, my coworker Susanna Smith blogged on Akimbo about the prevention of cervical cancer in low-resource settings. Here are some of the approaches to prevention she highlights:

…women in developing countries often do not get regular PAP smears because the test requires specialized equipment and advanced technical skills for which local practitioners don’t have the training. Another high-tech cervical cancer screening tool is colposcopy, which allows for the close inspection of the cervix with specialized equipment. Again, this is tool is not widely available in developing countries.


A DNA test for HPV is also available, which detects the presence of 13 of the most dangerous strains of HPV. Like the PAP, this test requires appropriate laboratory equipment and skilled lab technicians. A new version of this test called careHPV is currently being adapted for low-resource settings. It is expected that careHPV will be available in China by 2011 and in India by 2012. Healthcare providers with basic training could use this low-resource adaption even in places that lack electricity or running water. It produces results in less than three hours, allowing for same day treatment.

Though prevention, of course, is arguably better than treatment, condoms are not totally effective against HPV – HPV is spread by skin to skin contact, not through bodily fluids exchanged during partner sex play. And Gardasil, the HPV vaccine, is not readily and cheaply available throughout much of the developing world.

That said, a bit of infuriating sexual health and immigration discrimination: the United States makes the Gardasil vaccine mandatory for young women seeking U.S. citizenship. So this expensive vaccine is definitely a barrier to entry for young women seeking U.S. citizenship. Yet it isn’t required for American citizens – there has been serious outrage at this suggestion.

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9 comments for “Testing and Early Treatment: HPV & Cervical Cancer in Low-Resource Settings

  1. Kyra
    August 5, 2009 at 5:08 pm

    That said, a bit of infuriating sexual health and immigration discrimination: the United States makes the Gardasil vaccine mandatory for young women seeking U.S. citizenship.

    Makes it mandatory, but doesn’t pay for it? Honestly, I think that’s a little bit fucked there. Anything specifically mandated, in the health-care field especially, where somebody does not have the option of foregoing it,* ought to be provided at no cost to the person forced to get it.

    *At least, not without paying something far more expensive than the cost of the vaccine—giving up one’s desired homeland does NOT fall under “but she had a choice!”

  2. August 5, 2009 at 5:11 pm

    This is the U.S. government we’re talking about here, so OF COURSE it’s mandatory but immigrants are on their own to pay for it. And yes, it’s extremely fucked up, and discriminates against only women.

  3. Kristen J.
    August 5, 2009 at 5:17 pm

    This is ridiculous. Are there any resources for immigrant women in terms of helping them pay for it? I know the long term goal is to whack Congress over the head with a nerf bat fix the rules, but is there anything that can be done to help until the rules are changed?

  4. August 5, 2009 at 5:37 pm

    Kyra: it’s really typical in immigration situations to have a lot of mandatory medical stuff that is out of pocket. I don’t know the US situation very well, but Australia mandates TB X-Rays, a full medical workup, specialist investigations into any chronic symptoms (high BP etc etc) as part of immigration. Neither the Australian government nor insurers (Australia has public medicine for people who are already permanent residents, but potential immigrants need to be insured even if they’re applying from inside the country) will pay for the bulk of this, the specialist investigations perhaps excepted by some insurers.

    Which is really sucky, and especially so to impose extra costs on women. Immigration procedures are generally designed to make immigration as inaccessible as they can make it while still actually having some immigrants, because immigration is politically bad but economically desirable. (I realise this comment may come across as “that’s just the real world, it’s tough, get used to it” but I don’t intend that: this rigamarole is stupid and cruel in countries that impose it, and should be changed.)

  5. Maureen
    August 5, 2009 at 9:41 pm

    There is another cheap and easy way to head off cervical cancer in the developing world: “In 1999, with funding from the Bill & Melinda Gates Foundation, Jhpiego established its Cervical Cancer Prevention (CECAP) Program. Working with colleagues and stakeholders in Thailand, Ghana, Malawi and Peru, the CECAP program pioneered a unique, medically safe, acceptable and cost-effective approach to cervical cancer prevention for low-resource settings. This approach, known as the single visit approach (SVA), uses VIA to identify the precancerous cervical lesions, followed by treatment using a freezing technique to destroy the lesions (cryotherapy), in the same visit.”


    Granted, this is detection of the problem after it has manifest, but it is certainly better than nothing.

  6. MJ
    August 5, 2009 at 9:51 pm

    That said, a bit of infuriating sexual health and immigration discrimination: the United States makes the Gardasil vaccine mandatory for young women seeking U.S. citizenship.

    Great cheese on a cracker, you scared the bejesus out of me with that statement! No health requirements of any kind are in place for anyone seeking U.S. citizenship. For permanent residency (green card), yes, there is a physical (which I imagine includes a check for all requisite vaccines) that needs to be performed by a government approved doctor/clinic, but citizenship only requires a form, exorbitant fee to the tune of half a thousand dollars, and interview + civics test.

    Now, it’s true that you need to establish permanent residency before you can apply for citizenship, so one could make the argument that this vaccine is ultimately a requirement for citizenship, but please stop scaring those of us who got our green cards before that ridiculous rule was put in place. I just about near had a heart attack.

  7. August 5, 2009 at 11:59 pm

    @MJ – Really, its true. This rule is in effect for young women (not totally sure what their definition of “age-appropriate” is) as of August 1, 2008. Here’s the US Citizenship and Immigration Services announcement about the rule.

    You can, however, apply for a vaccination waiver based on religious and moral objections.

  8. MJ
    August 6, 2009 at 3:15 pm

    I know this rule is in place for people seeking permanent residency (green card), but it does not apply to those who have achieved permanent resident status before the rule was put in place and want to apply for U.S. citizenship.

    The page states:

    U.S. Citizenship and Immigration Services (USCIS) announced today a revised list of vaccines required for applicants seeking to adjust status to become legal permanent residents. (emphasis mine)

    Legal permanent residency is not the same thing as citizenship. It is the step before citizenship. So, as I’ve said before, while technically it’s true that this vaccine is required for any young woman who is currently not a permanent resident and will be seeking U.S. citizenship in the future, for those women who received their permanent resident status prior to August 1, 2008 and will be applying for naturalization when they are eligible in 5 years, no such requirement exists. Your statement is somewhat misleading; that’s what I was getting at.

  9. Annon
    August 12, 2009 at 6:51 pm

    Don’t miss the book “The HPV Vaccine Controversy: Sex, Cancer, God and Politics” authored by Shobha S. Krishnan, M.D, Barnard college, Columbia University. It is written without the influence of any pharmaceutical companies or special interest groups. The book educates both professionals and the public about HPV infections, the diseases they cause and the role/ controversies surrounding the new vaccines. The Journal of the American Medical Association (JAMA, June 17th 2009) calls the book superb and a terrific contribution to the field. It is available at amazon.com, Barnes and Noble .com and through international distributors. Link to the book: http://www.greenwood.com/catalog/C35011.aspx

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