Death rates from cervical cancer remain high in developing countries because women lack access to Pap tests and other effective screening programs, not because of the high prevalence of human papillomavirus (HPV) infection. Genital HPV is an extremely common sexually transmitted infection worldwide, yet in countries where women receive timely screening and treatment, rates of cervical cancer are low. Nevertheless, the new U.S. global AIDS law requires an analysis of HPV prevalence and a study of the impact of condom use on the spread of HPV in Sub-Saharan Africa, ostensibly in order to reduce deaths from cervical cancer. According to "HPV in the United States and Developing Nations: A Problem of Public Health or Politics?" by Cynthia Dailard, the experience of the United States and other developed countries suggests that the law's focus on HPV prevalence is misplaced, and will serve only to undermine confidence in condoms without doing anything to bring poor women the services they need to combat cervical cancer.
There are approximately 5.5 million new HPV infections in the United States each year, representing one-third of all new sexually transmitted infections. Nearly 3 in 4 Americans aged 15-49 have been infected at some point in their lives. Although most HPV infections are transient, women occasionally develop persistent infections. With certain strains of HPV (a few of the many types identified), these persistent infections may lead to cervical cancer.
Despite high rates of HPV infection, cervical cancer is relatively rare in the United States because of the widespread availability of Pap tests, and represents just one percent of all cancer deaths among women. Pap tests can detect precancerous changes of cervical cells and allow for the removal of affected tissue before invasive cancer sets in. Globally, however, it remains the third most common cancer, and 225,000 women die of the disease each year. Almost eighty-five percent of these deaths occur among women in developing countries where cervical screening programs are often unavailable.
Proponents of the focus on HPV in the U.S. global AIDS law contend that because genital HPV is spread through skin-to-skin contact and thus cannot be entirely prevented by condom use, only abstinence until marriage and lifelong monogamy within marriage can protect women against HPV and death from cervical cancer. The experience of the United States and other developed countries refutes this assertion. Moreover, latex condoms are scientifically proven to be an effective barrier against other sexually transmitted infections, including HIV. Using HPV as a means to undermine global confidence in condoms places men and women at tremendous risk of contracting a number of diseases, and does not address the problem at hand--a lack of access to cervical cancer screening among the world's poorest women.
Dailard's analysis appears in the August issue of The Guttmacher Report on Public Policy. Other analyses in this issue include: