Narrator: Shola is an African American single mother who while on a walk with her friend Raven became aware of what HPV was and the importance behind being vaccinated. She is concerned for her oldest daughter Nia, who recently told her that she was ready to be sexually active with her boyfriend. Raven works as a nurse at the nearby county hospital and does her best to educate Shola on what HPV is and why it is important for young girls like Nia to be vaccinated. Shola further reveals the barriers she feels stand in the way of getting Nia vaccinated, such as transportation and health insurance.  Her story highlights that of millions of minorities around the country who on average have much lower vaccine initiation rates compared to those who are White. Out of all marginalized groups of women, African American and Hispanic women have the highest odds of developing cervical cancer and also share the lowest uptake and completion rates of the vaccine (Ntiamoah, 2018). Multiple barriers stand in the way of low-income minorities receiving the HPV vaccine, such as HPV awareness, transportation to and from the clinic, and health insurance. Raven does her best to answer all of Shola's questions and concerns (Ntiamoah, 2018). 

 

Shola: I just don’t know what to do, Raven. Nia is only 13 and she just started dating this boy a month ago and now all of a sudden says she is ready to be sexually active with him. I am proud of her for feeling comfortable enough to discuss it with me, but I also don’t want her to get pregnant, or hurt. What do you think? Am I being a crazy parent?

 

Raven: I don’t think you’re being a crazy parent, I think you are being a concerned mother who wants to make sure her daughter is making the right choices and is safe. As women of color, we’re faced with the unfortunate task of taking extra precautions and being especially wary when it comes to interactions with institutions rooted in racist practice. Systemic racism spans from our interactions with law enforcement officers to our experiences in healthcare and medical settings.

 

Shola: You are so right! 

 

Raven: I will add, I think you should be concerned for other health factors that may affect Nia other than becoming pregnant, like contracting HPV.

 

Shola: HPV? What is that? Something you get from having sex? I am just starting nursing school but haven’t explored any of that yet if you don’t mind educating me.

 

Raven: Of course. I had no idea what HPV was either until I started nursing school so don’t feel bad for not knowing about it but you got one thing right, it is a sexually transmitted disease. HPV stands for Human Papilloma Virus and is the most common sexually transmitted disease out there. I’ll give you a little biology lesson on it. HPVs are tiny, non-enveloped double stranded DNA viruses that can infect our genital area and are primarily spread through sexual intercourse (Hirth, 2018) . There are over 200 types of the virus but the most common types, 6 and 11, are responsible for most cases of genital warts and are considered low-risk since they don’t lead to cancer, or other major health problems (Hirth, 2018). However, at least a dozen types of the virus, especially 16 and 18, lead to serious cases of cancer, especially cervical cancer, but can also cause cancer in the vulva, vagina, anus and mouth. Are you with me so far?

 

Shola: Yes, this is making me worried for Nia but please keep explaining. Is it only spread through sex and how would anyone know if they had it?

 

Raven: For the most part HPV is transmitted primarily through skin-skin contact but almost everyone gets it via sexual contact. Since it’s a skin-to-skin infection a couple doesn’t have to be having actual intercourse for it to be transmitted. The easiest way, without having been tested for someone to know if they have the virus is by visible genital warts or warts in their mouth and throat. I also read recently that the CDC estimated that roughly 80% of women will get at least one type of the virus at some point in their life, and that HPV causes 95% of anal cancers (Hirth, 2018). The scariest part, in my opinion, is that the types of HPV that cause cervical cancer don’t always show symptoms until the cancer has progressed to later stages. The cancer can also take years to fully evolve after someone gets HPV which is why being screened for it is so important!

 

Shola: So, how does one protect themselves against HPV? It’s not like these teens are going to stop having sex and I definitely don’t think I could stop Nia. I feel helpless.

 

Raven: Don’t feel helpless. Aside from using condoms and practicing safe sex the best way for one to be protected from HPV is by getting vaccinated! The HPV vaccine protects against the strains that cause a majority of the cervical cancers. The CDC urges that the vaccine be administered to boys and girls starting from the age of 12 through 2 or 3 doses, depending on age, each 6 months apart (Purdie, 2021). 

 

Shola: Wait, did you say two doses? Meaning two separate visits to the doctor?

 

Raven: Yes, but they are really quick and so worth it!

 

Shola: I am worried about how we would get there. Every day is a struggle to get around the city, and since I can’t afford a car let alone an uber I usually walk to the salon I work at and Nia always takes the bus to school. A major reason why I don’t ever consider visiting the doctor is because their offices are far, and since I work all day and get off late at night I just never have time to go anywhere.

 

Raven: I know transportation is an issue, especially if you don’t own a vehicle, but getting Nia to the clinic for both separate doses is important. You could borrow my car next week and take her to be vaccinated! Is transportation the only thing stopping you from going to the doctor’s office?

 

Shola: Sadly, no. Health insurance has been lingering in the back of my mind since we started discussing this.

 

Raven: I thought you had health insurance?

 

Shola: I have public health insurance, similar to Medicaid, but it isn’t the best insurance so I don’t know how I would be able to afford two or three separate visits to the doctor’s office plus the cost for the vaccine itself. I think one of the main reasons I haven’t visited a doctor in the last five years is because I don’t have the best health insurance. I have also witnessed family members receive bills from hospitals and doctor visits that they couldn’t afford and went into debt because of it.

 

Raven: If you have Medicaid they will pay for children up until the age of 18 to be vaccinated (Ntiamoah, 2018). There are also federally-financed vaccine programs that pay for vaccines, and immunization grant programs that could cover it. I do however understand your hesitancy behind it all. In fact, young adult women without health insurance were 86% less likely to get the vaccine in comparison to those with private health insurance (Ntiamoah, 2018). Not only that, but HPV vaccine awareness is much higher in those who have private health insurances so don’t be hard on yourself for not having known anything about HPV. Our healthcare system needs to be more inclusive for minorities like us.

 

Shola: Well, in that case, I will figure out a day my job will let me take some time off work and borrow your car to drive Nia to see the doctor. I also hope that they don’t give me any problems over our health insurance. I am really happy you took the time to explain all of this to me, Raven. Before this conversation, I had never even heard of HPV and would never have considered taking Nia to be vaccinated for it.

​

​