HPV Vaccination -- A Wasted Resource for African Americans?

The United States has no reporting system for Human Papillomavirus (HPV) infections. Infections and the development of warts appear to be common throughout life. In general, genital HPV infection is considered to have become dramatically more frequent over the past several decades. In the United States, young adults aged 15-24 years account for approximately one half of new HPV infections each year. The highest rate of infection is among young females aged 20-24 years. The US Centers for Disease Control and Prevention (CDC) estimates that there are 6 million new incidents a year in the United States (in 2008) and an estimated prevalence of more than 20 million.

HPV infection has been identified as a potential cofactor in a number of serious diseases, including cervical cancer, and even HIV infection. In the United States, African Americans have a rate of HPV infection that is 1.5 times higher than their white counterparts. One US survey reported that among women, the prevalence of HPV infection due to any HPV type was 39% for non-Hispanic blacks, and 24% for non-Hispanic whites and Mexican Americans. From 1987 to 1991, the age-adjusted cervical cancer death rate reported by the US National Cancer Institute was higher among black women than among white women, with a ratio of 6:1. HPV may also linger longer in African American women.

Because most HPV infections are transient, it is usually cleared by ones immune system within one or two years. However, a recent study of college aged women by the University of South Carolina found a tendency for more persistent HPV infection. It also found black women to have a 70% greater chance of abnormal pap smears than white women. A vaccine for HPV was first licensed in 2006. The vaccine, distributed under the name Gardasil, was the first vaccine known to protect against approximately 70% of the strains of cervical cancer in girls as well as roughly 90% of the strains that cause genital and anal warts. It was not for another 3 years before the vaccine was considered for use in boys and 2010 until it received licensure from the United States Food and Drug Administration for the prevention of cancer in boys, especially anal cancer.

However, despite its proven effectiveness, most African American young people are not accessing it. In 2010, only 1% of boys recommended to receive the vaccine did. Only 8% received one dose but did not complete the series. A recent survey of adolescent black girls and their caregivers conducted by the Pennsylvania Department of Public Health found that only one in four eligible black adolescent girls has received the vaccine. Many of the 71 young people surveyed, most of whom were black, expressed that they thought that the vaccine was "safe and effective." Moreover, the 45 caregivers who were surveyed agreed, but most of them said they didn't remember the HPV vaccine being mentioned by their health-care provider.

Young people, particularly minorities, and their parents/guardians need to edcuate themselves about HPV infection and vaccination and become their own advocates. They cannot assume that health care providers will mention it. Many are still struggling with performing routine testing of HIV. Vaccine is paid for by most insurances, is available at sites such as Planned Parenthood and will be required under the Affordable Care Act (Obamacare).