title: The association between knowledge of HPV and feelings of stigma, shame and anxiety.
abstract: OBJECTIVE
  To test the hypotheses that (1) women who know that human papillomavirus (HPV) is sexually transmitted will expect to experience higher levels of stigma, shame and anxiety if they test positive for the virus than women who are not aware of the mode of transmission and (2) women who are aware of the high prevalence of HPV infection will expect to experience lower levels of stigma, shame and anxiety than women who underestimate its prevalence.
  
  
  METHODS
  A web-based survey in which information about HPV was manipulated to generate a 2 x 2 design (awareness that HPV is sexually transmitted v no awareness; awareness of the high prevalence of HPV v no awareness). Participants (n = 811) were female students. They were asked to imagine that they had tested positive for HPV. Outcome measures were expected stigma, shame and anxiety.
  
  
  RESULTS
  Great differences were observed in emotional reactions to imagining testing HPV positive between the four groups based on knowledge of HPV. Knowledge of the prevalence was associated with lower levels of stigma, shame and anxiety. Knowledge that HPV is sexually transmitted was associated with higher levels of stigma and shame, but not anxiety. Women who knew that HPV is sexually transmitted but not that it is highly prevalent had the highest scores for stigma and shame.
  
  
  CONCLUSIONS
  Raising public awareness of the sexually transmitted nature of HPV has the potential to increase women's feelings of stigma and shame if they test positive for the virus. However, our findings suggest that ensuring women's awareness of HPV being common may reduce these feelings and also reduce anxiety, perhaps by "normalising" the infection.
authors.affiliation: Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK. j.waller@ucl.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Waller
authors.forename: L A V
authors.initials: LA
authors.lastname: Marlow
authors.forename: J
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety; D004644:Emotions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London; D030361:Papillomavirus Infections / Q000523:psychology*; D012752:Shame; D013240:Stereotyping